前列腺癌125I放射性粒子植入术后生化复发危险因素分析  

Prognostic Factors of Biochemical Relapse in Patients with Prostate Cancer After Brachytherapy

作　　者：蒋康 马立彬 蒋沛吾 陈可安 何晗 吴稚冰 于志坚 邓刚 Jiang Kang;Ma Libin;Jiang Peiwu(Department of Urology,Affiliated Hangzhou First People′s Hospital,Zhejiang University School of Medicine,Zhejiang 310006,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院泌尿外科,310006 [2]浙江大学医学院附属杭州市第一人民医院放疗科,310006 [3]浙江大学附属邵逸夫医院肾病科,杭州310020 [4]杭州市中医院普外科,310007

出　　处：《医学研究杂志》2019年第9期109-113,117,共6页Journal of Medical Research

基　　金：浙江省自然科学基金资助项目(LY17H050002、Y2111329);浙江省科技计划项目(2014C37016);浙江省中医药科研计划项目(2016ZB099、2013ZA107、2011ZB099);浙江省医药卫生科技计划项目(2011KYB066、2015KYB295);浙江省杭州市科技计划项目(2017A05、20110833B05、20110733Q12)

摘　　要：目的探讨前列腺癌125 I放射性粒子植入术后影响生化复发的相关因素。方法回顾性随访分析了笔者医院收治的51例接受前列腺癌125 I粒子植入术患者的临床资料,所有患者术前均未接受内分泌或其他治疗。年龄54~86岁,平均年龄74.25岁;初始PSA 1.14~286.57μg/L,<20.0μg/L者33例,≥20.0μg/L者18例;临床分期T 1c^T 3b;前列腺体积19.49~83.90ml,平均39.72ml;D 90(包容90%靶区体积的剂量值)为136.9~173.9Gy,平均147.17Gy;术后最低PSA为0~22.99μg/L,平均1.19μg/L;PSAD为0.05~9.87μg/(L·cm^3),平均0.81μg/(L·cm^3);其中22例联合使用内分泌治疗,2例联合使用了外放疗。分析无生化复发率与粒子植入组中患者危险分级、初始PSA值、Gleason评分、临床分期、前列腺体积、D 90、术后最低PSA、PSAD的关系。结果随访时间1~38个月,中位随访时间17个月,平均随访时间20.16个月。16例出现生化复发。低中危组、高危组的3年无生化复发率分别为54.4%、32.5%,组间比较可见差异趋势(P=0.273)。D 90≥145Gy者无生化复发率高于D 90<145Gy者,组间比较差异有统计学意义(P=0.040);术后最低PSA<1μg/L者无生化复发率优于最低PSA≥1μg/L者,组间比较差异有统计学意义(P=0.001)。结论D 90、术后最低PSA与生化复发密切相关;危险分期、前列腺体积、是否联合内分泌表现了与生化复发相关的趋势。Objective To investigate the prognostic factors of biochemical relapse in patients with prostate cancer after brachytherapy for improving the therapeutic effects.Methods 51 patients with prostate cancer underwent brachytherapy in our hospital(age 54-86 years,media 74.25 years)were analysed.All the patients didn′t accept endocrine therapy or other therapy before brachytherapy.The PSA ranged from 1.14-286.57μg/L,in which 33 cases with PSA<20.0μg/L and 18 cases with PSA≥20.0μg/L.Clinical stage ranged from T 1c to T 3b.The prostate volume ranged from 19.49 to 83.90ml(average,39.72ml).The D 90[minimal dose(Gy)received by 90%of the prostate gland]ranged from 136.9 to 173.9Gy(average,141.17Gy).The PSA nadir after brachytherapy ranged from 0 to 22.99μg/L(average,1.19μg/L).The PSAD ranged from 0.05 to 9.87μg/(L·cm^3)[average,0.81μg/(L·cm^3)].And 22 patients were treated with endocrine therapy in combination.2 patients were treated with external beam radiation in combination.The 3 years biochemical no evidence of disease(3y-bNED)rate was recorded.The correlation of risk stratification PSA,Gleason score,clinical stage,prostate volume,D 90,the PSA nadir after brachytherapy and PSAD with biochemical relapse were analyzed by using SPSS 23.0 software.Results The patients were followed up from 1 to 38 months(average,20.16 months;median,17 months).And biochemical relapse was observed in 16 cases(3y-bNED rate,43.3%).The 3y-bNED rates in low&intermediate-risk and high-risk groups were 54.4%,32.5%.The biochemical no evidence of disease(bNED)rate was significantly higher in patients with the following factors,namely D 90≥145Gy(P=0.040),the PSA nadir after brachytherapy<1μg/L(P=0.001).Conclusion Significant correlations are found between bNED rate and risk stratification.And higher incidence of biochemical relapse could be found in patients with D 90≥145Gy or the PSA nadir after brachytherapy<1μg/L.

关 键 词：前列腺癌 内放疗 生化复发 危险因素 

分 类 号：R6[医药卫生—外科学]