局限性中高危前列腺癌近距离治疗联合内分泌治疗和外放疗的疗效分析  

The outcomes of brachytherapy combined with external beam radiotherapy and hormonal therapy for local high-risk or intermediated-risk prostate cancer

作　　者：严维刚[1] 周智恩[1] 周毅[1] 李汉忠[1] 纪志刚[1] 张福泉[2] 邱杰[2] 徐梅 李宁宁 

机构地区：[1]中国医学科学院北京协和医院泌尿外科,100730 [2]中国医学科学院北京协和医院放疗科100730 [3]中国医学科学院北京协和医院手术室100730

出　　处：《中华泌尿外科杂志》2017年第6期442-447,共6页Chinese Journal of Urology

摘　　要：目的分析近距离治疗联合内分泌治疗和外放疗在局限性中高危前列腺癌患者中的疗效。方法回顾性分析2003年12月至2012年3月收治的354例局限性中高危前列腺癌患者的临床资料。年龄48～84岁，平均72．4岁。中危患者111例，高危患者243例。术前PSA3．8—99．8ng／ml，平均29．6ng／ml。Gleason评分4～9分，平均6．8分。前列腺体积13．7—65．0fill，平均30．5m1。354例均接受近距离治疗联合内分泌治疗，其中69例另外接受外放疗。术后随访观察无生化进展生存率、无远处转移生存率、疾病特异性生存率、总生存率及并发症。结果本组354例中174例明确诊断后即行前列腺癌近距离治疗，157例先行最大限度雄激素阻断内分泌治疗（maximalandrogenblockade，MAB），3个月后再行前列腺癌近距离治疗，余23例因前列腺体积较大，术前MAB治疗延长至6个月。所有354例术后均联合MAB治疗，其中111例中危患者均接受6个月MAB治疗，243例高危患者接受6个月至3年的MAB治疗。354例中69例除接受MAB治疗外，术后还给予辅助性外放疗。354例术后随访9～128个月，平均91个月。135例出现生化复发，63例出现远处转移，81例死亡，其中24例死于前列腺癌，57例死于其他非相关疾病。术后总体无生化进展生存率为61．9％，无远处转移生存率为82．2％，总生存率为77．1％，疾病特异性生存率为93．2％；其中中危患者的上述指标分别为83．8％、100．0％、91．9％、100．0％，明显优于高危患者（51．9％、74．1％、70．4％、81．5％，均P〈0．001）。术后尿潴留发生率为6．8％（24／354），远期尿道狭窄发生率为1．7％（6／354），未发生前列腺直肠瘘等严重并发症。结论近距离治疗联合内分泌治疗和外放疗治疗局限性中高危前列腺癌疗效肯定、创伤小，术后并发症少。Objective To evaluate the outcomes and complications of permanent brachytherapy combined with external beam radiotherapy and hormonal therapy for local high-risk or intermediated-risk prostate cancer. Methods There were 354 men with local high-risk or intermediated-risk prostate cancer were reviewed, including 11 l men with local intermediated-risk prostate cancer and 243 men with local high- risk prostate cancer. The age of the patients were 48 to 84 years old （mean age 72.4 years old）. The preoperative PSA levels were in a range of 3.8 to 99.8ng/ml （ mean 29.6 g/ml） and the preoperative Gleason scores were 4 to 9 （mean 6.8）. The prostate volume were 13.7 to 65.0 ml （ mean 30.5 ml）. All the patients were treated with brachytherapy combined with hormonal therapy, including 69 patients received additional external beam radiotherapy. All patients were followed up for biochemical progression-free survival （bPFS） , distant disease free survival （DDFS） , overall survival （OS） , cause-specific survival （CSS） rate and complications. Results Among 354 cases, 174 cases underwent brachytherapy after the diagnosis of prostate cancer, and 157 cases underwent braehytherapy after maximal androgen blockade （MAB） treatment for 3 months, while the other 23 patients with large prostate underwent brachytherapy after MAB treatment for 6 months. All 354 cases were treated with MAB after brachytherapy. One hundred and eleven cases in intermediated-risk group were treated with MAB for 6 months and 243 cases in high-risk group were treated with MAB for 6 months to 3 years. Another 69 patients received adjuvant external radiotherapy. All cases were followed up for 9 to 128 months （mean 91 months ）, including 135 cases having biochemical recurrence, and 63 cases having distant metastasis. There were 81 cases died, including 24 cases died of prostate cancer. The overall bPFS, DDFS, OS and CSS were 61. 9%, 82. 2% , 77. 1% and 93. 2% respectively. There were significant difference in the survival rate

关 键 词：前列腺癌 近距离治疗 治疗结果 手术后并发症 

分 类 号：R737.25[医药卫生—肿瘤]