近距离放疗治疗≤cT3期前列腺癌的远期疗效及影响预后的危险因素  

Clinical outcomes and predictors of≤cT3prostate cancer treated by 125I low-dose-rate prostate brachytherapy

作　　者：王增增 李月明 徐勇[2] WANG Zengzeng;LI Yueming;XU Yong(Department of Urology,Beichen District Traditional Chinese Medicine Hospital,Tianjin,300400,China;Department of Urology,Second Hospital of Tianjin Medical University)

机构地区：[1]天津市北辰区中医医院泌尿外科,天津300400 [2]天津医科大学第二医院泌尿外科

出　　处：《临床泌尿外科杂志》2024年第4期301-306,共6页Journal of Clinical Urology

摘　　要：目的:分析125I粒子植入近距离放疗治疗≤cT3期前列腺癌的临床效果,探讨影响术后无生化复发生存率(biochemical relapse-free survival, bRFS)和总生存率(overall survival, OS)的相关因素。方法:回顾性分析2006年1月—2016年12月于天津医科大学第二医院经125I粒子植入放疗的116例≤cT3期前列腺癌患者的临床资料。采用Kaplan-Meier法统计患者术后5、8年的bRFS、OS;分别采用Log-rank法和Cox比例风险模型评估穿刺活检前前列腺特异性抗原(PSA)值、穿刺病理Gleason评分、临床T分期、穿刺活检阳性针数率、危险度分级、前列腺体积与患者术后bRFS、OS的关系。结果:5、8年bRFS分别为75.0%、56.0%;5、8年OS分别为80.2%、62.1%;Gleason评分、穿刺活检阳性针数率、临床T分期、前列腺体积是bRFS的独立预测因素,而Gleason评分、临床T分期是OS的独立预测因素(P<0.05);对于≤cT3a期前列腺癌,Gleason评分、穿刺活检阳性针数率、前列腺体积、危险度分级均是bRFS独立预测因素(P<0.05),而Gleason评分是OS的独立预测因素(P<0.05)。结论:125I粒子植入治疗低危组前列腺癌效果理想;中、高危组,尤其是T3a~T3b期及Gleason评分≥8分者,应考虑结合外放疗和内分泌治疗;腺体体积较大不影响术后bRFS和OS;穿刺活检阳性针数率偏高者,术后应加强对PSA值的监测,必要时行穿刺活检,明确复发原因,并给予针对性治疗。Objective:To evaluate the outcomes of low-dose-rate prostate brachytherapy(LDR-BT)and investigate the prognostic factors of biochemical relapse-free survival(bRFS)and overall survival(OS)in≤cT3prostate cancer after LDR-BT.Methods:One hundred and sixteen patients with≤cT3prostate cancer treated with 125I LDR-BT as monotherapy or combined with homonal therapyfrom Jan,2006to Dec,2016in Second Hospital of Tianjin Medical University were retrospectively collected.Log-rank test and multivariable Cox regression were used to evaluate the relationship between covariates(PSA,clinical stage,prostate volume,et.al)and bRFS,OS.Results:Five-and eight-year bRFS and OS were 75.0%and 56.0%,80.2%and 62.1%,respectively;Multivariate Cox analysis showed that Gleason score,the percentage of positive biopsy cores(%PC),clinical T stage and PV were correlated with bRFS;Gleason score and clinical T stage were correlated with OS;For patients with≤cT3aprostate cancer,Gleason score,%PC,PV and risk group were correlated with bRFS;Only Gleason score was an independent predictor of OS.Conclusion:Low-risk PCa patients are the most suitable candidates for LDRBT,while the intermediate-or high-risk PCa,specially for stage cT3a-cT3bor Gleason score≥8,LDR-BT combined with external radiotherapy and hormone therapy may be considered.Very large PV does not influence bRFS rate or OS.The PCa with high%PC should be paid more attention to biochemical recurrence(BCR),even biopsy when necessary,to clarify the cause of BCR for definite therapy.

关 键 词：前列腺癌 近距离放疗 生化复发 危险因素 

分 类 号：R737.25[医药卫生—肿瘤]