前列腺癌冷冻治疗的远期疗效及预测因素  

Long-term prognostic predictors of prostate cancer patients who underwent cryotherapy

作　　者：万方宁 戴波 叶碧然 林国文 叶定伟 Wan Fangning;Dai Bo;Ye Biran;Lin Guowen;Ye Dingwei(Department of Urology,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai Genitourinary Cancer Institute,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院泌尿外科复旦大学上海医学院肿瘤学系

出　　处：《中华泌尿外科杂志》2024年第6期451-455,共5页Chinese Journal of Urology

摘　　要：目的探讨真实世界下前列腺冷冻消融术治疗前列腺癌的疗效及其预后因素。方法回顾性分析2021年1月至2023年12月复旦大学附属肿瘤医院收治的105例前列腺癌患者的临床资料。根据患者远处转移情况分为无转移组62例(58.7%),转移组43例(41.3%)。无转移组中位年龄79(73,82)岁,初诊前列腺特异性抗原(PSA)20(10,47)ng/ml,接受新辅助内分泌治疗37例(59.7%),术前PSA8(2,14)ng/ml;国际泌尿病理协会(ISUP)分级1级4例(6.5%),2级11例(17.7%)3级16例(25.8%),4级16例(25.8%),5级15例(24.2%);T_(2)期49例,T_(3)期6例,T_(4)期7例;N_(0)期62例(100.0%),N_(1)期0例。转移组中位年龄68(62,74)岁,初诊PSA64(27,200)ng/ml,接受新辅助内分泌治疗42例(97.7%),术前PSA0(0,3)ng/ml;ISUP分级1级0例,2级5例(11.6%),3级3例(7.0%),4级19例(44.2%),5级16例(37.2%);T_(2)期29例(67.4%),T_(3)期8例(18.6%),T_(4)期6例(14.0%);N_(0)期38例(88.4%),N_(1)期5例(11.6%);M_(1a)期5例(11.6%),M_(1b)期35例(81.4%),M_(1c)期3例(7.0%)。两组比较,T分期差异无统计学意义(P=0.346),其他指标差异均有统计学意义(P<0.05)。前列腺癌冷冻消融术采用全麻或局部浸润麻醉,患者取截石位,留置F20三腔导尿管持续冲洗。在经直肠超声引导下,平行探头经会阴插入冷冻针,针尖距膀胱壁的安全距离为3mm。采用全腺体冷冻模式,从患者腹侧开始向直肠侧逐层消融。采用超声实时观察冰球位置和范围,消融过程中调整冰球范围,使其与前列腺边缘贴合,同时保护周围结构。消融结束后,拔除冷冻针,碘伏消毒穿刺点后纱布压迫止血20s至无出血后贴敷料。术后10d拔除导尿管。术后第1天以及术后6、12周复查PSA。将术后第1天PSA与术前PSA比值定义为PSA释放率。术后生化复发定义为PSA较术后最低值升高超过0.2ng/ml。比较两组的无PSA进展生存时间和并发症发生情况。结果本研究所有手术均顺利完成。无转移组和转移组的PSA释放率分别为4.2Objective To explore the efficient prognostic factors of cryotherapy for prostate cancer in the real-world setting.Methods The clinical data of 105 prostate cancer patients treated at the Fudan University Shanghai Cancer center from January 2021 to December 2023 were analyzed retrospectively.The patients were divided into a non-metastatic group(62 cases,58.7%)and a metastatic group(43 cases,41.3%)based on the presence or absence of distant metastasis.In the non-metastatic group,the median age was 79 years(range 73 to 82),the initial PSA was 20 ng/ml(range 10 to 47),37 cases(59.7%)received neoadjuvant endocrine therapy,and the preoperative PSA was 8 ng/ml(range 2 to 14).The ISUP grades were Grade 1 in 4 cases(6.5%),Grade 2 in 11 cases(17.7%),Grade 3 in 16 cases(25.8%),Grade 4 in 16 cases(25.8%),and Grade 5 in 15 cases(24.2%).The T-stages were T_(2)in 49 cases,T_(3)in 6 cases,and T_(4) in 7 cases.All cases were No.In the metastatic group,the median age was 68 years(range 62 to 74),the initial PSA was 64 ng/ml(range 27 to 200),42 cases(97.7%)received neoadjuvant endocrine therapy,and the preoperative PSA was O ng/ml(range 0 to 3).The ISUP grades were Grade 1 in 0 cases,Grade 2 in 5 cases(11.6%),Grade 3 in 3 cases(7.0%),Grade 4 in 19 cases(44.2%),and Grade 5 in 16 cases(37.2%).The T-stages were T_(2) in 29 cases(67.4%),T_(3) in 8 cases(18.6%),and T_(4) in 6 cases(14.0%).The N-stages were N_(0)in 38 cases(88.4%)and N_(1)in 5 cases(11.6%).The M-stages were M/a in 5 cases(11.6%),Mu,in 35 cases(81.4%),and Mr.in 3 cases(7.0%).The dfference in T-stage between the two groups was not statistically significant(P=0.346),while differences in other indicators were statistically significant(P<0.05).The cryotherapy for prostate cancer was performed under general or local anesthesia,with the patients in the lithotomy position and a F20 three-lumen catheter was placed for continuous irrigation.Under transrectal ultrasound guidance,the cryoprobes were inserted parallel to the probe through the perineum,with a safe distance of 3 mm fr

关 键 词：前列腺癌 冷冻消融 预后 真实世界 

分 类 号：R737.25[医药卫生—肿瘤]