多发转移性前列腺癌患者新辅助治疗后行减瘤性前列腺根治性切除术的探讨  

Study on performing cytoreductive radical prostatectomy after neoadjuvant therapy in patients with multiple metastatic prostate cancer

作　　者：周哲[1] 晋连超[1] 杨冰[1] 汪磊[1] 潘东亮[1] 张志宏[1] 贺利军[1] 王义[1] 李宁忱[1] ZHOU Zhe;JIN Lianchao;YANG Bing;WANG Lei;PAN Dongliang;ZHANG Zhihong;HE Lijun;WANG Yi;LI Ningchen(Department of Urology,Peking University Shougang Hospital,Beijing 100144,China)

机构地区：[1]北京大学首钢医院泌尿外科,北京100144

出　　处：《中国医药科学》2021年第10期16-21,共6页China Medicine And Pharmacy

基　　金：北京市石景山区医学重点支持专科建设项目(2018004)。

摘　　要：目的探讨在多发转移性前列腺癌患者新辅助治疗后转移灶减少或消失的患者中,减瘤性前列腺根治性切除术(CRP)的安全性以及效果。方法回顾性分析我院确诊的多发转移性前列腺癌行辅助治疗后转移灶减少或消失,且在2017年5月至2018年7月之间行腹腔镜CRP手术的患者共6例,随访截止至2020年6月。所有纳入研究的患者均行筋膜外途径腹腔镜根治性前列腺切除术。记录患者的术中及术后的临床指标,包括手术时间、术中出血量、术后住院时间、留置尿管时间、引流时间、术后Gleason评分、T分期、淋巴结阳性、切缘阳性、术后1个月及1年尿控、术后1个月前列腺特异性抗原(PSA)、术后辅助治疗方案、随访时间、目前PSA、以及是否发展为去势抵抗性前列腺癌(CRPC)。比较术前和术后1个月PSA有无统计学意义。结果6例患者均顺利行腹腔镜前列腺根治性切除术,无中转开放,术后均顺利拔管出院。术后病理局部晚期(≥T3b)患者达50%;33.3%的患者术后淋巴结阳性及切缘阳性;83.3%的患者术后1年达到尿控;平均随访29.5个月,有1例患者发展为CRPC。除病例3术前及术后PSA均为0外,其余5例患者术后1个月PSA均较术前有所下降,差异有统计学意义(Z=-2.019,P=0.043)。结论对于新辅助治疗后转移灶减少或消失的转移性前列腺癌患者,选择合适的病例,由经验丰富的医生实施减瘤性前列腺根治性切除术,具有安全性;减瘤性根治性前列腺切除术能否给患者带来生存获益仍需进一步的研究。Objective To explore the safety and effect of cytoreductive radical prostatectomy(CRP)in patients with multiple metastatic prostate cancer whose metastases have decreased or disappeared after neoadjuvant therapy.Methods The clinical data of 6 patients with multiple metastatic prostate cancer diagnosed in our hospital who had reduced or disappeared metastases after adjuvant therapy and who received laparoscopic CRP surgery from May 2017 to July 2018 were retrospectively analyzed.The follow-up ended in June 2020.All patients included in the study underwent extrafascial laparoscopic radical prostatectomy.The patients'intraoperative and postoperative clinical indicators were recorded,including operation time,blood loss,postoperative hospital stay,duration of indwelling urinary catheter,drainage time,postoperative Gleason score,T stage,positive lymph nodes,positive resection margins,urination control at 1 month and 1 year after surgery,prostate-specific antigen(PSA)at 1 month after surgery,postoperative adjuvant treatment plan,follow-up time,current PSA,and whether it had developed into castrate-resistant prostate cancer(CRPC).Compare whether there was a significant difference in PSA before surgery and 1 month after surgery.Results All 6 patients successfully underwent laparoscopic radical prostatectomy without conversion to open surgery and were extubated and discharged from the hospital after surgery.50%of patients had locally advanced pathology(≥T3b)after surgery.33.3%of patients had positive lymph nodes and positive resection margins after surgery.83.3%of patients achieved urination control at 1 year after surgery.With an average follow-up of 29.5 months,1 patient developed into CRPC.Except for case 3 whose PSA was 0 ng/ml before and after surgery,the PSA of the other 5 patients at 1 month after surgery decreased compared with that before operation,with statistically significant difference(Z=-2.019,P=0.043).Conclusion For patients with metastatic prostate cancer who have reduced or disappeared metastases after n

关 键 词：多发转移性前列腺癌 新辅助治疗 减瘤性前列腺根治性切除术 去势抵抗性前列腺癌 

分 类 号：R737.25[医药卫生—肿瘤]