Akakura K, Akimoto S, Shimazaki J
Department of Urology, School of Medicine, Chiba University, Japan.
J Cancer Res Clin Oncol. 1996;122(10):633-7. doi: 10.1007/BF01221197.
It is of clinical importance to control pain in the management of patients with endocrine-therapy-refractory prostate cancer. To evaluate factors influencing the manifestation of pain and the relationship between characteristics of pain and prognosis, patients with pain from bone metastasis were analyzed. A total of 48 patients with endocrine-therapy-refractory prostate cancer, who showed progression of bone metastasis and were followed-up until death, comprised the present study. The patients were divided into three groups according to the grade of pain: no need for analgesics, a need for non-opioid analgesics, and a need for opioid analgesics. The time interval between the diagnosis of the endocrine-therapy-refractory state and the requirement for analgesics was estimated. Survivals from the endocrine-therapy-refractory state were calculated according to the grade of pain or the time interval to requirement for analgesics. In addition, the extent of disease, the doubling time of tumor markers at the refractory state, any change of alkaline phosphatase, and other prognostic factors were examined in relation to pain. All 22 endocrine-therapy-resistant cases at initial treatment and 18 of 26 (69%) relapsed cases required analgesics during the clinical course until death. No difference in survival was observed between the grades of pain. The patients who needed analgesics within 1 year after becoming refractory to endocrine therapy showed significantly shorter survival than those without or with analgesics more than 1 year later. Although the time elapsing before analgesics were needed was not related to the extent of disease, the patients who showed a shorter doubling time for tumor markers and/or an exponential increase in alkaline phosphatase tended to require analgesics within 1 year. In endocrine-therapy-refractory prostate cancer, the early requirement for analgesics suggests poor prognosis, and the onset of pain may be attributable not to the extent of the disease but rather to the rapid expansion of bone metastasis.
在内分泌治疗难治性前列腺癌患者的管理中，控制疼痛具有临床重要性。为了评估影响疼痛表现的因素以及疼痛特征与预后之间的关系，对骨转移疼痛患者进行了分析。本研究共纳入48例内分泌治疗难治性前列腺癌患者，这些患者均出现骨转移进展并随访至死亡。根据疼痛程度将患者分为三组：无需使用镇痛药、需要非阿片类镇痛药、需要阿片类镇痛药。估计了内分泌治疗难治状态诊断至需要使用镇痛药的时间间隔。根据疼痛程度或至需要使用镇痛药的时间间隔计算内分泌治疗难治状态后的生存期。此外，还研究了疾病范围、难治状态时肿瘤标志物的倍增时间、碱性磷酸酶的任何变化以及其他预后因素与疼痛的关系。所有22例初始治疗时内分泌治疗耐药的病例以及26例复发病例中的18例（69%）在临床病程直至死亡期间均需要使用镇痛药。不同疼痛程度之间未观察到生存期差异。内分泌治疗难治后1年内需要使用镇痛药的患者生存期明显短于1年后无需使用或需要使用镇痛药的患者。虽然至需要使用镇痛药的时间与疾病范围无关，但肿瘤标志物倍增时间较短和/或碱性磷酸酶呈指数升高的患者往往在1年内需要使用镇痛药。在内分泌治疗难治性前列腺癌中，早期需要使用镇痛药提示预后不良，疼痛的发生可能并非归因于疾病范围，而是骨转移的快速进展。
