| Objective:Although PSA is widely used in prostate cancer,However,there is not enough research on predicting the prognosis of prostate cancer patients during PSA decline after treatment.For example,prognostic study of PSA kinetic changes on hormone sensitive survival after treatment.So we put forward the concept of PSA percentage decline rate was proposed to explore the hormone-sensitive survival of robot-assisted radical prostatectomy combined with hormonal therapy and hormonal therapy alone,and to provide a reference index for the prognosis of patients with prostate cancer.Methods:Medical data of a total of 145 prostate cancer patients prostate cancer diagnosed pathologically in The First Affiliated Hospital of Nanchang University from January2017 to June 2019 were retrospectively collected.According to different treatment schemes,they were divide into two groups.79 patients received robot-assisted radical prostatectomy combined with hormonal therapy(RARP+HT group),while 66 patients received hormonal therapy alone(OHT group).The differences of basic information(age,prostate volume,body mass index),clinical features(clinical stage,bone metastasis,lymph node metastasis,puncture Gleason score)and PSA related indicators(PSA value before and after treatment,interval time of PSA review,PSA decline rate,PSA percentage decline rate)were compared between the two groups.Not development of castration resistant prostate cancer after treatment is considered to be during hormone sensitive survival.Kaplan-Meier survival method and Cox proportional hazard model were used to analyze the hormone-sensitive survival prognostic factors of prostate cancer patients in this study.Results:No significant difference was found in the age,prostate volume,and body mass index between the RARP+HT group and the OHT group(P> 0.05).The clinicalfeatures of the two groups were compared,clinical stage,bone metastasis,lymph node metastasis,Gleason score were statistically significant(P<0.05).According to PSA before treatment,PSA after treatment and interval time of PSA review,the PSA decline rate and PSA percentage decline rate of RARP+HT group and OHT group are calculated respectively.No statistical difference was noted in PSA decline rate in RARP+HT and OHT group(P>0.05).However,PSA percentage decline rate was significantly higher in RARP+HT group(p<0.001).Kaplan-Meier survival analysis combined with Log-rank test showed that there was significant difference in hormone sensitive survival between RARP+HT group(median survival time was 18.6 months)and OHT group(median survival time did not appear).Hormone resistance was more likely to occur in OHT group than RARP+HT group(HR:7.02;95%CI:3.51-14.04;P<0.001).And there were statistical differences in hormone sensitive survival among different clinical features.COX univariate analysis showed that prognostic factors for hormone-sensitive survival were associated with surgery;PSA percentage decline rate;Clinical stage?T2c;bone metastasis(oligometastasis,extensive metastasis);Lymph node metastasis;Gleason score8-10 and PSA value before treatment.COX multivariate analysis showed that extensive bone metastasis(HR:4.291;95%CI:1.507-12.214;P=0.006)and PSA percentage decline rate(HR:0.845;95%CI:0.736-0.970;P=0.016)were independent prognostic factors for hormone-sensitive survival.Conclusion:1.The independent prognostic factors of hormone-sensitive survival in patients with prostate cancer underwent robot-assisted radical prostatectomy combined with hormonal therapy and hormonal therapy alone were extensive bone metastasis and PSA percentage decline rate.2.K-M survival analysis showed that Robot-assisted radical prostatectomy combined with hormonal therapy may have better tumor control requires than hormonal therapy alone,but it may be affected by clinical feature.3.The results of COX multivariate analysis show that the concept of PSA percentage decline rate can be used as an effective reference indicator for the prognosis of patients with PCa. |
PDF Full Text Request