初始治疗采用根治性切除术或近距离放射治疗对高危前列腺癌患者预后的影响  

Effects of radical resection or brachytherapy as initial treatment on the prognosis of patients with high-risk prostate cancer

作　　者：徐耀宗 丁雪飞[2] 朱良勇 章俊 施国伟 XU Yaozong;DING Xuefei;ZHU Liangyong;ZHANG Jun;SHI Guowei(Department of Urology,The Fifth People's Hospital of Shanghai,Fudan University,Shanghai 200240;Department of Urology,Subei People's Hospital of Jiangsu Province,Yangzhou 225001,China)

机构地区：[1]复旦大学附属上海市第五人民医院泌尿外科,上海200240 [2]江苏省苏北人民医院泌尿外科,江苏扬州225001

出　　处：《现代泌尿外科杂志》2024年第3期238-243,共6页Journal of Modern Urology

基　　金：闵行区公共卫生重点学科项目(No.MGWXK2023-07);上海市第五人民医院院级课题基金项目(No.2022WYFY04)。

摘　　要：目的探讨初始治疗采用前列腺根治性切除术(RP)或近距离放射治疗(BT)对高危前列腺癌患者预后的影响,为临床治疗方案的选择提供参考。方法提取SEER数据库2005-2014年133191例接受RP或BT治疗的高危前列腺癌患者的临床资料。采用K-M分析以及单因素、多因素Cox回归分析比较患者5年和10年的肿瘤特异性生存率(CSS)和总生存率(OS)。同时收集苏北人民医院2015-2020年诊断为高危前列腺癌患者253例,其中接受RP者153例,接受BT者100例,采用K-M分析比较患者5年无生化复发生存期(bPFS)和5年CSS。结果基于SEER数据库资料的单因素分析结果显示:BT与较高的死亡风险相关(HR=1.319,95%CI:1.256~1.386,P<0.001);年龄、婚姻状况和TNM分期也均与较高的死亡风险相关(P<0.001)。多因素分析调整相关变量后结果显示:与RP比较,BT并不会导致较高的死亡风险(HR=0.964,95%CI:0.924~0.996,P=0.808)。从OS生存曲线图发现,观测的生存时间越长,RP的OS越优于BT(P<0.001);但CSS生存曲线图发现,观测的生存时间越长,BT的CSS优势要大于RP(P<0.001)。单中心数据分析得出BT相较于RP在5年bPFS(P=0.263)和5年CSS(P=0.946)差异均无统计学意义。结论对于高危前列腺癌患者,如没有控制年龄、婚姻状况、TNM分期等因素,两种治疗方法的预后存在区别,初始治疗RP疗效优于BT,特别是预期寿命>10年的患者,但控制了可能的混杂因素后两种治疗方法的预后差异无统计学意义。因此对于这类患者的初始治疗选择应当多角度衡量,充分告知后尊重患者选择。Objective To investigate the effects of radical prostatectomy(RP)or brachytherapy(BT)on the prognosis of patients with high-risk prostate cancer as initial treatment,in order to provide a reference for the selection of clinical treatment options.Methods The clinical data of 133191 patients diagnosed with high-risk prostate cancer and treated with RP or BT during 2005 and 2014 were extracted from the SEER database.The 5-year and 10-year cancer-specific survival(CSS)and overall survival(OS)were compared with K-M analysis and univariate and multivariate Cox regression.The clinical data of another 253 patients diagnosed with high-risk prostate cancer in Subei People's Hospital during 2015 and 2020 were collected,including 153 patients who received RP and 100 patients who received BT.The 5-year biochemical progress-free survival(bPFS)and CSS were compared with K-M analysis.Results Univariate analysis of SEER data showed that BT was associated with a higher risk of death(HR=1.319,95%CI:1.256-1.386,P<0.001);age,marital status and TNM stage were associated with higher risk of death(P<0.001).Multivariate analysis,adjusted for relevant variables,showed that BT did not result in a higher risk of death compared with RP(HR=0.964,95%CI:0.924-0.996,P=0.808)。The OS curve showed that the longer the observed survival time,the better OS of RP as compared to BT(P<0.001);however,the CSS survival curve showed that the longer the observed survival time,the better CSS of BT compared to RP(P<0.001).The single-center data analysis showed no significant difference between BT and RP in the 5-year bPFS(P=0.263)and CSS(P=0.946).Conclusion For patients with high-risk prostate cancer,there is a significant difference in the prognosis of the two treatments if there is no adjustment of age,marital status,TNM stage and other factors,and the efficacy of RP is better than that of BT,especially in patients with survival more than 10 years.However,there is no statistically significant difference in the prognosis after the possible confounding factor

关 键 词：高危前列腺癌 前列腺癌根治术 近距离放射治疗 SEER数据库 肿瘤特异性生存率 总生存率 无生化复发生存期 

分 类 号：R737.25[医药卫生—肿瘤]