内分泌治疗在根治性前列腺癌切除术后病理特征阴性患者中的临床疗效  

Clinical Efficacy of Endocrine Therapy in Patients with Negative Pathological Features After Radical Prostatectomy

作　　者：侯亚坤 黄新 周星宇 陶宁 安恒庆[1] 王文光[1] HOU Ya-kun;HUANG Xin;ZHOU Xing-yu;TAO Ning;AN Heng-qing;WANG Wen-guang(Department of Urinary Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,Xinjiang,China)

机构地区：[1]新疆医科大学第一附属医院泌尿外科,新疆乌鲁木齐830054

出　　处：《医学信息》2024年第1期158-162,共5页Journal of Medical Information

摘　　要：目的探讨局限性高危型根治性前列腺癌切除术后同时满足病理分期<T3、淋巴结阴性、切缘阴性、脉管侵犯阴性及术后即刻患者PSA降至<0.1 ng/ml患者内分泌治疗的效果。方法回顾性分析我院2016年1月-2022年12月行腹腔镜下根治性前列腺癌切除术且术后病理特征同时满足病理分期<T3、淋巴结阴性、切缘阴性、脉管侵犯阴性及术后即刻患者PSA降至<0.1 ng/ml的90例局限性高危型前列腺癌患者,根据不同治疗方案分为腹腔镜下前列腺癌根治术+内分泌治疗(RP+ADT)组和腹腔镜下前列腺癌根治术后随访(RP)组,每组45例。比较两组总生化复发率、1年、2年、3年生化复发率、PSA无进展生存期,内分泌治疗不良反应。结果两组总生化复发率、1年、2年、3年生化复发率、PSA无进展生存期比较,差异均无统计学意义(P>0.05),RP+ADT组内分泌治疗后1例术后轻度肉眼血尿,1个月后自愈,13例潮热,3例肝毒性(轻度转氨酶升高),1例骨质疏松,1例脑梗死亡。内分泌治疗不良反应例数较少无法进行统计学分析。结论对于病理特征同时满足病理分期<T3、淋巴结阴性、切缘阴性、脉管侵犯阴性及术后即刻患者PSA降至<0.1 ng/ml的局限性高危型前列腺癌术后患者推荐术后3年内随访观察,3年后根据患者PSA上升情况决定后续治疗。Objective To investigate the effect of endocrine therapy in patients with pathological stage<T3,lymph node negative,negative margin,negative vascular invasion and immediate postoperative PSA reduction<0.1 ng/ml after localized high-risk radical prostatectomy.Methods A retrospective analysis of 90 patients with localized high-risk prostate cancer who underwent laparoscopic radical prostatectomy in our hospital from January 2016 to December 2022 and whose postoperative pathological features met pathological stage<T3,negative lymph node,negative margin,negative vascular invasion,and PSA decreased to<0.1 ng/ml immediately after surgery.According to different treatment options,they were divided into laparoscopic radical prostatectomy+endocrine therapy(RP+ADT)group and laparoscopic radical prostatectomy follow-up(RP)group,with 45 patients in each group.The total biochemical recurrence rate,1-year,2-year,3-year biochemical recurrence rate,PSA progression-free survival,and adverse reactions of endocrine therapy were compared between the two groups.Results There was no significant difference in the total biochemical recurrence rate,1-year,2-year,3-year biochemical recurrence rate and PSA progression-free survival between the two groups(P>0.05).In the RP+ADT group,1 case had mild gross hematuria after endocrine therapy,and recovered after 1 month;13 cases had hot flashes,3 cases had hepatotoxicity(mild transaminase elevation),1 case had osteoporosis and 1 case had cerebral infarction.The number of adverse reactions of endocrine therapy was small and could not be statistically analyzed.Conclusion For patients with localized high-risk prostate cancer whose pathological features meet the pathological stage<T3,lymph node negative,negative margin,negative vascular invasion and immediate postoperative PSA reduction to<0.1 ng/ml,it is recommended to follow up for 3 years after surgery.After 3 years,follow-up treatment is determined according to the increase of PSA in patients.

关 键 词：高危前列腺癌 腹腔镜下前列腺癌根治术 病理特征阴性 内分泌治疗 

分 类 号：R737.25[医药卫生—肿瘤]