实用医学杂志 ›› 2023, Vol. 39 ›› Issue (4): 460-464.doi: 10.3969/j.issn.1006⁃5725.2023.04.013

• 临床研究 • 上一篇    下一篇

减瘤性前列腺癌根治术联合内分泌治疗在寡转移前列腺癌患者中的疗效及预后观察 

丁琪 孙慕斌 金晓华 范志江 屠文健 李锋 石轶 范波    

  1. 苏州大学附属常熟医院,常熟市第一人民医院泌尿外科(江苏常熟 215500)

  • 出版日期:2023-02-25 发布日期:2023-02-25
  • 通讯作者: 范波 E⁃mail:fanbo_cs@sina.com
  • 基金资助:
    苏州市科技发展计划项目(编号:SYSD2018013);常熟市卫生和计划生育委员会科技计划项目(编号:csws201812)

Efficacy and prognosis of cytoreductive radical prostatectomy combined with androgen deprivation therapy for oligometastatic prostate cancer

DING Qi,SUN Mubin,JIN Xiaohua,FAN Zhijiang,TU Wenjian,LI Feng, SHI Yi,FAN Bo.   

  1. Department of Urology,the Changshu Hospital Affiliated to Soochow University,Changshu NO.1 People′s Hospital,Changshu 215500,China

  • Online:2023-02-25 Published:2023-02-25
  • Contact: FAN Bo E⁃mail:fanbo_cs@sina.com

摘要:

目的 探讨减瘤性前列腺癌根治术(cytoreductive radical prostatectomy,CRP)联合内分泌治 疗(androgen deprivation therapy,ADT)在寡转移前列腺癌中的手术效果及预后。方法 纳入 2015 6 月至 2021 3 月收治的寡转移前列腺癌患者 67 例,32 例行 CRP 联合 ADT 治疗(CRP 组),35 例行单纯 ADT 治疗 ADT 组)。记录 CRP 组围手术期数据、两组进展至 CRPC 时间及肿瘤特异性生存期(cancer specific sur⁃ vival,CSS),运用 Kaplan⁃Meier 法比较。结果 两组(PSA)水平,Gleason 评分,临床 T、N 分期差异无统计 学意义。CRP组Clavien⁃DindoⅠ级并发症 2 例,Ⅱ级并发症 9 例,并发症发生率为 34.38%。CRP 20 例进 展至CRPC,中位进展时间为26个月,ADT组21例进展至CRPC,中位进展时间为19个月。两组激素依赖性 生存期差异有统计学意义(P < 0.001)。Cox多因素回归分析显示CRP是延长寡转移前列腺癌进展至CRPC 的独立保护因素(HR = 0.276,95%CI:0.136 ~ 0.558,P < 0.001)。两组 CSS 差异无统计学意义(P = 0.452)。 结论 CRP 联合 ADT 治疗寡转移前列腺癌并发症较少,安全性好,与单纯 ADT 治疗相比,能延缓寡转移前 列腺癌患者进展至CRPC 的时间。

关键词:

寡转移前列腺癌, 减瘤性前列腺癌根治术, 内分泌治疗, 预后, 影响因素

Abstract:

Objective To investigate the clinical outcomes of cytoreductive radical prostatectomy(CRP combined with androgen deprivation therapy(ADT)for oligometastatic prostate cancer. Methods A total of 67 patients with oligometastatic prostate cancer were enrolled in the study from June 2015 and March 2021. Of the patients,32 were treated with CRP combined with ADT and 35 were treated with ADT alone. The perioperative outcomes were evaluated,the time to CRPC and cancer specific survival(CSS)were observed and compared by Kaplan⁃Meier method. Results No statistical differences in PSA levels,distribution of clinical tumor stage and nodal stage were noted between the two groups. The incidence of postoperative complications in CRP group was 34.38%. Two patients experienced Clavien⁃Dindo I complications,while nine patients experienced Clavien⁃Dindo Ⅱ complications. Tewnty patients progressed to CRPC in the CRP group and 21 in the ADT group. The median time to CRPC was significantly longer among the CRP group(26 months)compared with the ADT group(19 months). Multivariate analysis identified CRP as a significant predictor for delaying the progression to CRPC. There was no difference in CSS between the two groups. Conclusions CRP combined with ADT was effective in oligometastatic prostate cancer by delaying the progression to CRPC with few minor complications.

Key words:

oligometastatic prostate cancer, cytoreductive radical prostatectomy, androgen depriva? tion therapy, prognosis, influence factor