根治性前列腺切除术后挽救性放疗的预后分析  

Prognostic factors of salvage radiotherapy after radical prostatectomy

作　　者：刘洋 文凤[2] 沈亚丽[2] 潘麒文 何金霞 麦丽欣 曾浩[4] 高剑铭[1] 李响[4] 李志平[3] 李永红[5] 王辛[2] 何立儒[1] 魏强[4] 周芳坚[5] Liu Yang;Wen Feng;Shen Yali;Pan Qiwen;He Jinxia;Mai Lixin;Zeng Hao;Gao Jianming;Li Xiang;Li Zhiping;Li Yonghong;Wang Xin;He Liru;Wei Qiang;Zhou Fangjian(Department of Radiation Oncology,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060,China;Department of Abdominal Oncology of Cancer Center,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Radiation Oncology of Cancer Center,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Urology,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Urology,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060,China)

机构地区：[1]中山大学肿瘤防治中心放疗科,华南肿瘤学国家重点实验室,肿瘤医学协同创新中心,广州510060 [2]四川大学华西医院肿瘤中心腹部肿瘤科,成都610041 [3]四川大学华西医院肿瘤中心放射治疗科,成都610041 [4]四川大学华西医院泌尿外科,成都610041 [5]中山大学肿瘤防治中心泌尿外科,华南肿瘤学国家重点实验室,肿瘤医学协同创新中心,广州510060

出　　处：《中华泌尿外科杂志》2021年第9期650-655,共6页Chinese Journal of Urology

摘　　要：目的探讨根治性前列腺切除术后行挽救性放疗患者的预后情况。方法回顾性分析2014年5月至2020年12月中山大学肿瘤防治中心和四川大学华西医院收治的248例根治性前列腺切除术后接受挽救性放疗患者的临床资料。中位年龄66(45~87)岁,术前中位前列腺特异性抗原(PSA)23.50(0.18~845.00)ng/ml。病理分期:T2期99例(40%),T3a期49例(20%),T3b期78例(32%),T4期15例(6%),分期不详7例(3%);N0期153例(62%),N1期44例(18%),不详51例(21%);切缘阳性165例(67%)。术后Gleason评分6分12例(5%),7分104例(42%),8分34例(14%),>8分90例(36%),不详8例(3%)。术后出现生化进展(定义为术后6~8周PSA≤0.1ng/ml,后期出现PSA>0.1ng/ml且持续上升,或连续3次检测PSA持续上升)143例(58%),PSA持续(定义为术后6~8周PSA>0.1ng/ml)105例(42%)。放疗前去势抵抗性前列腺癌70例,激素敏感性前列腺癌178例。117例(47%)行早期挽救性放疗(放疗前PSA≤0.5 ng/ml),131例(53%)行晚期挽救性放疗(放疗前PSA>0.5 ng/ml);182例(73%)放疗联合内分泌治疗。采用χ^(2)检验比较放疗后PSA下降情况,Kaplan-Meier法和log-rank检验比较放疗后无进展生存时间(PFS),采用单因素和多因素Cox回归模型分析影响PFS的因素。结果放疗后PSA应答(PSA下降≥50%)率为94%(233/248),PSA下降≥90%者203例(82%),12例(5%)放疗结束时PSA升高,但仅4例(2%)此后持续上升。放疗后中位PFS为69(95%CI 68~70)个月,3、5年无进展生存率分别为80%、67%。生化进展患者与PSA持续患者的PFS差异无统计学意义(HR=0.71,95%CI 0.37~1.37,P=0.311),早期挽救性放疗患者的PFS较晚期挽救性放疗患者更长[69(95%CI 68~70)个月与59(95%CI 44~74)个月,P<0.001]。放疗时激素敏感性患者较去势抵抗性患者的5年无进展生存率更高(74%与51%,P<0.001)。多因素分析结果显示,Gleason评分>8分、放疗时处于去势抵抗性阶段和晚期挽救性放疗为预后不良的危险因素(均P<0.05)。结论对根治性前列腺切�Objective To investigate the prognosis after salvage radiotherapy with or without hormone therapy for prostate cancer.Methods From May 2014 to December 2020,248 patients undergoing salvage radiotherapy due to prostate-specific antigen(PSA)persistence or biochemical progression after radical prostatectomy at Sun Yat-sen University Cancer Center(n=157)and West China Hospital,Sichuan University(n=91)were analyzed.Median age was 66(45-78)years old.Median PSA was 23.50(0.18-845.00)ng/ml.The number of PSA persistence and biochemical progression were 143(59%)and 105(42%).The number of pT2,pT3a,pT3b,pT4,and unknown T stage was 99,49,78,15 and 7 cases.The number of N0,N1 and unknown N stage was 153,44 and 51 cases.165 cases had positive surgical margin.Gleason score of 6,7,8,>8 score and unknown was in 12,104,34,90 and 8 patients.Early and late salvage radiotherapy was performed in 117 and 131 patients,and 70 patients(28%)were CRPC.Hormone therapy was used combined with radiotherapy in 182 patients(73%).PSA decline after radiotherapy was compared with Chi-squre test.Kaplan-Meier method and log-rank test were used to compare progression free-survival(PFS)after radiotherapy.Univariate and multivariate analyses of PFS were performed using Cox proportional hazards model.Early salvage radiotherapy was defined as PSA≤0.5 ng/ml before radiotherapy,and late salvage radiotherapy was defined as PSA>0.5ng/ml.Results PSA response(PSA decline≥50%)rate was 94%(233/248),and 82%(203/248)patients had PSA decline≥90%.Twelve(5%)patients had rising PSA after completing radiotherapy,but only 4(2%)had real progression.The median PFS was 69 months(95%CI 68-70),and 3-year and 5-year PFS rate were 80%and 67%.PFS of PSA persistence and biochemical progression were similar(HR=0.71,95%CI 0.37-1.37,P=0.311).Compared with late salvage radiotherapy,early salvage radiotherapy had better PFS[69(95%CI 68-70)vs.59(95%CI 44-74)months,P<0.001].Compared with hormone sensitive,castration-resistant was associated with worse PFS(5-year PFS rate 74%vs.51%,P

关 键 词：前列腺肿瘤 生化进展 前列腺特异性抗原持续 挽救性放疗 预后 

分 类 号：R737.25[医药卫生—肿瘤]