전립선암 환자에서 병용호르몬차단요법 후 호르몬비의존성전립선암으로 진행을 예측할 수 있는 인자
Predictive Variables of the Progression to Androgen Independent Prostate Cancer after Combined Androgen Blockade
박승철, 임정식, 이상은, 최한용, 홍성준, 김청수, 김원재, 윤진한, 송재만,
소속 상세정보
박승철 ( Park Seung-Chol )
원광대학교 의과대학 비뇨기과학교실
임정식 ( Rim Joung-Sik )
원광대학교 의과대학 비뇨기과학교실, 원광의과학연구소
이상은 ( Lee Sang-Eun )
서울대학교 의과대학 비뇨기과학교실
최한용 ( Choi Han-Yong )
성균관대학교 의과대학 비뇨기과학교실
홍성준 ( Hong Sung-Joon )
연세대학교 의과대학 비뇨기과학교실, 비뇨의과학연구소
김청수 ( Kim Choung-Soo )
울산대학교 의과대학 비뇨기과학교실
김원재 ( Kim Wun-Jae )
Chungbuk National University
윤진한 ( Yoon Jin-Han )
동아대학교 의과대학 비뇨기과학교실
송재만 ( Song Jae-Mann )
연세대학교 원주의과대학 비뇨기과학교실
KMID : 0358320070480040408
Abstract
Purpose: Despite of the effectiveness of androgen deprivation therapy for prostate cancer, it progress to androgen independent prostate cancer (AIPC) after various periods of time. The objective of this study was to analyze the clinical and pathological variables that predict progression to AIPC after combined androgen blockade(CAB).
Materials & Methods: We retrospectively reviewed the medical records of 343 patients who were treated with CAB for prostate cancer. Binary logistic regression test was used to analyze the independent predictors for the progression to AIPC. The time to AIPC, according to variables, was assessed by the Kaplan-Meier method and the variables were compared using the Log-Rank test.
Results: The mean follow-up was 42.1 months(range: 12-120). Seventy seven patients (33.3%) experienced progression to AIPC at a median of 20.2 months (range: 6-72). On univariate analysis, the percentage of positive prostate biopsies, the Gleason score, the T stage, the extent of bone metastasis, lymph node metastasis, the pretreatment PSA level, the nadir PSA and the PSA level at 3 and 6 months all had a significant relationship with the progression to AIPC. The receiver operating characteristic curve analysis for the nadir PSA showed that the optimal cut-off point to predict progression to AIPC was 0.5ng/ml with an area under curve of 0.769. A multivariate analysis demonstrated that the Gleason score(＞7), the nadir PSA(＞0.5ng/ml), and the PSA level at 6 months(＞4.0ng/ml) were significantly correlated with the progression to AIPC.
Conclusion: This study suggested that Gleason score, the nadir PSA and the PSA level at 6 months were independent variables to predict progression to AIPC after CAB. The PSA level at 6 months may be the most accurate variable to predict progression to AIPC. (Korean J Urol 2007; 48:408-415)
키워드
Prostate cancer;Hormone;Progression
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