Analysis Of Relationship Of Clinical Factors And Prognosis Of Prostate Cancer With Osseous Metastases

Objective To explore the clinical factors in the patients with prostate cancer associated with bone metastases and the relationship between PSA prostate kinetics and the survival after treat with the maximal androgen blockade.Method A retrospective analysis was used to analyze the patients in Ningxia medical university hospital from Jan. 2009 to Jan. 2013. All of these patients have been treated with maximal androgen blockade. The collected data include PSA, TNM Staging, number or extents of bone metastases, Gleason Scores, Clinical data and the PSA kinetics dynamic data after maximal androgen blockade treatment.Results 1.The Spearman regression analysis showed that TNM Staging has a positive regression with Gleason scores(r=0.232,P=0.034) and extents of bone metastases(r=0.231,P=0.030), and there was a positive regression between extents of bone metastases and ALP(r=0.536,P=0.000).2.there was a significant difference in PSAV(Z=-2.701,P=0.001), PSA nadir(Z=-2.252,P=0.022), and PSA nadir maintenance time between dead group and survival group. And the TNM staging and the extents of bone metastases were also have a significant in those two groups.3.The COX regression model of death showed that t PSA and PASV were the risk factors in patients with prostate cancer and osseous metastases, while the time of progression-free-survival was the protect factor.4.The COX regression analysis showed that the nadir PSA and Gleason scores were risk factors for progressing to castration resistant prostate cancer in the patients with prostate cancer and osseous metastases(OR=1.344,95%CI=1.108,1.632;OR=1.791,95%CI=1.218,2.504).5.With the help of receiver operating characteristic curve,we identified that,in our study,the best cut-off of PSA nadir was 0.201/ml(sensitivity 92.9 specificity55.9%), area under the curve was 0.782±0.069, When PSA nadir ≤0.201 ng/ml*month prompt prognosis is good. The best cut-off for PSAV was 4.45 ng/ml* month(sensitivity 87.5% and specificity 93.33%),area under the curve was 0.958±0.027, When PSAV ≤4.45 ng/ml*month prompt prognosis is good.6.We used Kaplan-Meier curve showed that the PSA nadir≤0.201 ng/ml patients for 1 years, 2 years, 5 years survival rate were 100%, 100%, 93.33%, the PSA nadir>0.201 ng/ml patients for 1 years, 2 years, 5 years survival rate were 95.24%、80.95%、31.17%, the PSAV≤4.45 ng/ml* month patients for 1 years, 2 years, 5 years survival rate were 100%、100%、80%,the PSAV>4.45 ng/ml* month patients for 1 years, 2 years, 5 years survival rate were 87.5%、5%、0%. Log-rank test showed significant < 0.001.Conclusion 1.In clinical factors of patients, Gleason score was positively related with tumor TNM stage, scope and bone metastases tumor TNM stage were positively correlated, alkaline phosphatase were positively correlated to the areas of bone metastases.2.In this study, the survival prognosis related factors affecting PSAV, PSA nadir, areas of bone metastases, abdominal and pelvic lymph nodes metastasis and TNM Staging of tumor. The PSAV are risk factors for death events and progression free survival time was the protective factor.3.With the help of ROC curve and Kaplan-Meier curve,we identified that the best cut-off of PSA nadir was 0.201/ml and the best cut-off for PSAV was 4.45 ng/ml* month. Patients who received endocrine therapy has the lower PSA nadir PSAV rose more slowly prompt prognosis will be good.