寡转移性PCa新辅助内分泌治疗后RARP与仅行RARP的短期临床疗效对比  

Comparative of the surgical clinical outcomes between RARP after neoadjuvant hormonal therapy and RARP alone for oligometastatic prostate cancer

作　　者：程晓锋 许嵩 周晓晨[1] 张成[1] 王共先[1] CHENG Xiaofeng;XU Song;ZHOU Xiaochen;ZHANG Cheng;WANG Gongxian(Department of Urology,First Affiliated Hospital of Nanchang University,Nanchang,330006,China)

机构地区：[1]南昌大学第一附属医院泌尿外科,南昌330006

出　　处：《临床泌尿外科杂志》2021年第8期627-632,共6页Journal of Clinical Urology

摘　　要：目的:比较新辅助内分泌治疗(NHT)后行机器人辅助腹腔镜根治性前列腺切除术(RARP)与仅行RARP治疗寡转移性前列腺癌(PCa)的短期临床疗效。方法:回顾性分析2015年1月—2020年8月期间南昌大学第一附属医院确诊的50例寡转移性PCa患者的临床资料,根据术前是否行NHT分为NHT+RARP组(20例)和RARP组(30例),收集统计所有患者的一般临床资料及围手术期资料。结果:两组手术均获得成功,无中转开放手术。两组的手术时间、术中估计出血量、切缘阳性、精囊侵犯、Clavien-Dindo手术并发症分级以及术后住院时间比较,差异均无统计学意义;而两组在包膜侵犯、尖端阳性及术后病理T分期方面进行比较,差异均有统计学意义。NHT+RARP组经NHT治疗后可明显缩小术前前列腺体积、降低血清前列腺特异性抗原(PSA)水平,且差异有统计学意义。结论:在寡转移性PCa患者中行NHT可潜在地获益,可明显降低术前血清PSA水平、缩小前列腺体积,同时可降低包膜侵犯和尖端阳性的风险,但并没有显著降低手术时间、术中估计出血量、术后住院时间、术后Gleason评分、精囊侵犯、淋巴结阳性以及手术切缘阳性结果。因此,对于寡转移性PCa患者而言,术前行NHT是一种可选择的治疗方式,尤其是术前高PSA水平、前列腺体积较大的患者。Objective:To compare the surgical clinical outcomes of robot-assisted laparoscopic radical prostatectomy(RARP)after neoadjuvant hormonal therapy(NHT)and RARP alone in the treatment of oligometastatic prostate cancer.Methods:A retrospective analysis of the clinical data of 50 patients with oligometastatic prostate cancer diagnosed in First Affiliated Hospital of Nanchang University from January 2015 to August 2020 was done.According to whether NHT was performed before surgery,they were divided into NHT+RARP group 20 cases and RARP group 30 cases.The general clinical data and perioperative data of all included patients were collected and statistically analyzed.Results:All operation of both groups were successful,and there was no transfer to open surgery.There was no significant difference between the two groups in operation time,estimated intraoperative blood loss,positive resection margin,seminal vesicle invasion,Clavien-Dindo surgical complications classification,or postoperative hospital stay.The difference between the two groups in terms of capsule invasion,apex of prostate positive and postoperative pathological T staging was statistically significant.After NHT treatment in the NHT+RARP group,the preoperative prostate volume and the serum prostate-specific antigen(PSA)level can be significantly reduced,and the difference was statistically significant.Conclusion:Patients with oligometastatic prostate cancer can potentially benefit from NHT.It can significantly reduce preoperative serum PSA levels and prostate volume,while reducing the risk of capsule invasion and apex of prostate positive,but it does not significantly reduce the operation time of surgery,estimated intraoperative blood loss,postoperative hospital stay,postoperative Gleason score,positive rate of seminal vesicle invasion,lymph node or surgical resection margin.Therefore,for patients with oligometastatic prostate cancer,preoperative NHT is an alternative treatment,especially those with high PSA level and larger prostate volume.

关 键 词：前列腺癌 寡转移 新辅助内分泌治疗 根治性前列腺切除术 

分 类 号：R737.25[医药卫生—肿瘤]