戈舍瑞林联合醋酸阿比特龙新辅助治疗局部进展期前列腺癌的临床分析(附31例报告)  

Clinical analysis of goserelin combined with abiraterone neoadjuvant therapy for locally advanced prostate cancer(Report of 31 cases)

作　　者：文思杰 蔡燚 陈敏丰[1] WEN Sijie;CAI Yi;CHEN Minfeng(Department of Urology,Xiangya Hospital,Central South University,Changsha,410008,China)

机构地区：[1]中南大学湘雅医院泌尿外科,长沙410008

出　　处：《临床泌尿外科杂志》2022年第10期735-738,共4页Journal of Clinical Urology

基　　金：湖南省重点领域研发计划(No:2021SK2014)。

摘　　要：目的探讨戈舍瑞林联合醋酸阿比特龙新辅助治疗局部进展期前列腺癌的临床疗效及安全性。方法回顾性分析中南大学湘雅医院2020年9月—2021年8月共31例行戈舍瑞林联合醋酸阿比特龙新辅助治疗患者的临床资料。新辅助治疗方案戈舍瑞林10.8 mg皮下注射(每12周1次),醋酸阿比特龙1 g口服(每日1次),泼尼松5 mg口服(每日2次),共24周。全部患者新辅助治疗后行腹腔镜下前列腺癌根治术+盆腔扩大淋巴结清扫术。患者中位年龄66(64,72)岁,中位初诊前列腺特异性抗原(PSA)63.7(26.87,100)ng/mL。临床分期:cT_(2)期4例,cT_(3)期23例,cT_(4)期4例;cN_(0)期16例,cN_(1)期15例。穿刺病理ISUP分级分组:3组8例,4组7例,5组16例。分析患者PSA变化水平、病理完全缓解和微小残留病变率、切缘阳性率以及所有与治疗相关的不良反应。结果新辅助治疗后中位PSA 0.101(0.06,1.57)ng/mL,术后29例(93.5%)达根治水平(术后6周T-PSA<0.2 ng/mL),其中4例(12.9%)术后病理提示病理完全缓解和微小残留病变,术后切缘阳性4例。新辅助治疗期间未出现3~5级不良反应,其中3例患者出现了肝功能损伤2级,予以对症支持2周治疗后肝功能恢复正常。根治术后随访6~24个月,7例随访期间出现生化复发,其中2例出现局部复发,1例出现远处转移。结论戈舍瑞林联合醋酸阿比特龙新辅助治疗局部进展期前列腺癌可获得较高的病理完全缓解和微小残留病变率,不良反应可控。Objective To investigate the clinical efficacy and safety of goserelin combined with abiraterone acetate in neoadjuvant treatment of locally advanced prostate cancer.Methods The clinical data of 31 patients undergoing neoadjuvant therapy with goserelin combined with abiraterone acetate from September 2020 to August 2021 in Xiangya Hospital of Central South University were retrospectively analyzed.The neoadjuvant treatment regimen included goserelin 10.8 mg subcutaneously(once every 12 weeks),abiraterone acetate 1 g orally(once a day),and prednisone 5 mg orally(twice a day)for 24 weeks.All patients underwent laparoscopic radical prostatectomy and enlarged pelvic lymph node dissection after neoadjuvant therapy.The median age of the patients was 66(64,72)years,and the median newly diagnosed PSA was 63.7(26.87,100)ng/mL.Four cases were in cT_(2)stage,23 cases in cT_(3)stage,4 cases in cT_(4) stage,16 cases in cN_(0)stage,and 15 cases in cN_(1)stage.According to biopsy pathology ISUP grading,8 cases were grouped in group 3,7 cases in group 4,and 16 cases in group 5.PSA levels,pathological complete remission and minimal residual disease rates,positive margins,and all treatment-related adverse reactions were analyzed.Results After neoadjuvant therapy,the median PSA was 0.101(0.06,1.57)ng/mL,and 29 patients(93.5%)reached the radical level after surgery(T-PSA<0.2 ng/mL at 6 weeks after surgery),of which 4 patients(12.9%)showed pathological complete remission and minimal residual disease according to postoperative pathology.Postoperative margins were positive in 4 cases.There were no grade 3-5 adverse reactions during neoadjuvant therapy,and 3 patients had grade 2 liver function damage.After 2 weeks of symptomatic support,the liver function returned to normal.During the follow-up period of 6 to 24 months after radical resection,7 patients developed biochemical recurrence during the follow-up period,including 2 patients with local recurrence and 1 patient with distant metastasis.Conclusion Goserelin combined with abirateron

关 键 词：局部进展期前列腺癌 新辅助治疗 醋酸阿比特龙 不良反应 

分 类 号：R737.25[医药卫生—肿瘤]