病理Gleason评分≥8分的前列腺癌行根治术预后的影响因素  

Prognostic factors of prostatic cancer patients with Gleason score of 8 or higher after radical prostatectomy

作　　者：宣寒青[1] 薛蔚[1] 沙建军[1] 王元天[1] 李东[1] 薄隽杰[1] 周立新[1] 黄旭元[1] 刘东明[1] 黄翼然[1] 

机构地区：[1]上海交通大学医学院附属仁济医院泌尿科,200127

出　　处：《上海医学》2011年第7期504-507,共4页Shanghai Medical Journal

摘　　要：目的评估前列腺癌根治术后病理Gleason评分≥8分患者的预后及其影响因素。方法回顾性分析2002年1月—2008年12月行根治性前列腺切除术的前列腺癌患者的临床资料,术后定期门诊随访。入选标准:前列腺根治术后Gleason评分≥8分,术前未接受新辅助内分泌治疗,随访资料完整。应用Kaplan-Meier Logrank检验及Cox回归进行单因素及多因素分析,评估影响预后的因素。结果 29例患者符合入选标准。平均随访时间为(51.7±25.8)个月,16例(55.2%)患者生化复发,5年无生化复发率为40.2%。5年肿瘤特异性生存率为95.8%,5年总生存率为84.8%。单因素分析显示,辅助治疗组5年无生化复发率为75.2%,显著高于未行辅助治疗组的0(χ2=11.514,P=0.001);辅助内分泌治疗联合放疗组5年无生化复发率为100.0%,显著高于辅助内分泌治疗组(60.0%)及未行辅助治疗组(0,χ2=12.369,P=0.002)。将年龄、术前前列腺特异性抗原(PSA)水平、病理Gleason评分、病理分期、切缘及辅助治疗类型纳入多因素分析模型,结果显示辅助治疗类型是高级别前列腺癌根治术后无生化复发生存时间的显著预测因素(P=0.006),前列腺癌根治术后辅助内分泌治疗联合放疗显著延长Gleason评分≥8分患者的无生化复发生存时间。结论病理Gleason评分≥8分,精囊侵犯及切缘阳性率高,较早出现生化复发,需谨慎选择前列腺癌根治性手术。术后辅助内分泌治疗联合放疗的综合治疗可显著延长无生化复发生存时间。Objective To evaluate the prognoses and the prognosis factors of protatic cancer patients with Gleason score ≥8 after radical prostatectomy. Methods We retrospectively reviewed the data of 321 patients who underwent radical prostatectomy between 2002 and 2008. The Inclusion criteria were.. Gleason score ≥8; receiving no neoadjuvant therapy before surgery; and the patients were followed up regularly after operation. Kaplan-Meier Logrank and Cox regression model were used for univariable and multivariable analyses to assess the factors influencing their prognoses. Results Totally 29 patients were included and they were followed up for a mean of （51.7±25.8） months. Sixteen patients had biochemical recurrence （55.2%） and 5-year biochemical recurrence-free survival rate was 40.2 % in our group. The 5-year cancer-specific survival rate and overall survival rate was 95.8 % and 84.8 %, respectively. Univariate and multivariate analyses showed that the adjuvant therapy type was the only significant predictor of biochemical recurrence-free survival（P 〈0.01）. Adjuvant androgen deprivation therapy plus radiotherapy significantly improved the biochemical recurrence-free survival in patients with Gleason score ≥8 after radical prostatectomy. Conclusion For patients with Gleason score ≥ 8, tumor staging, seminal vesicle invasion, positive surgical margin, and postoperative adjuvant therapy are the factors influencing the prognoses of prostatic cancer patients. Multi-modal treatment like adjuvant androgen deprivation therapy plus radiotherapy can greatly improve the biochemical recurrence-free survival.

关 键 词：前列腺癌 GLEASON评分 预后 

分 类 号：R737.25[医药卫生—肿瘤]