前列腺癌根治术后挽救性放疗的临床疗效及对患者控尿功能恢复影响的研究  

Clinical efficacy of salvage radiotherapy after radical prostatectomy and its potential impact on urinary incontinence recovery

作　　者：杨长珉 詹江涛 车宪平[2] 王鹏飞 蒙绪松 邓康俐 胡志全[4] 胡鑫明[2] YANG Changmin;ZHAN Jiangtao;CHE Xianping;WANG Pengfei;MENG Xusong;DENG Kangli;HU Zhiquan;HU Xinming(Second Clinical College of Hainan Medical University,Haikou,570100,China;Department of Urology,Second Affiliated Hospital of Hainan Medical University;Department of Urology,Hubei Cancer Hospital,Huazhong University of Science and Technology;Department of Urology,Tongji Hospital,Huazhong University of Science and Technology)

机构地区：[1]海南医学院第二临床学院,海口570100 [2]海南医学院第二附属医院泌尿外科 [3]华中科技大学同济医学院附属湖北肿瘤医院泌尿外科 [4]华中科技大学同济医学院附属同济医院泌尿外科

出　　处：《临床泌尿外科杂志》2024年第7期571-576,581,共7页Journal of Clinical Urology

基　　金：海南省自然科学基金高层次人才(No:821RC713)。

摘　　要：目的:局限性高危前列腺癌患者在接受根治性前列腺切除术(radical prostatectomy,RP)后当出现生化复发(biochemical recurrence,BCR)或局部肿瘤复发(local recurrent disease,LRD)时通常需要接受挽救性放疗(salvage radiotherapy,SRT)治疗。本文研究了RP术后出现BCR或LRD并接受SRT治疗后患者的临床疗效。方法:回顾性分析海南医学院第二附属医院2006年9月—2018年9月局限性高危前列腺癌患者在RP治疗后出现BCR或LRD并接受了SRT治疗后的临床疗效及对控尿功能恢复的影响。主要研究终点为尿失禁发生率(urinary incontinence rate,UIR),次要研究终点为无生化进展生存期、无远处转移生存期、癌症特异性生存期及总生存期。此外,因放疗而引起的胃肠道系统(gastrointestinal,GI)和泌尿生殖系统(genitourinary,GU)的近期(90 d内)和远期(90 d后)不良反应(adverse effects,AEs)也纳入分析研究。结果:总共有85例患者纳入研究。中位随访时间为86(24,152)个月。有65例(76.5%)患者在SRT前具有满意的控尿功能。在接受了SRT后这65例患者中分别有2例(2.4%)和3例(3.5%)出现近期和远期CTCAE≥2级尿失禁。而在其余20例(23.5%)SRT前已有尿失禁症状的患者中,在接受了SRT后有1例(1.2%)患者在近期和远期均恢复了控尿功能,剩下的19例(22.4%)患者在近期保持稳定,此外有2例(2.4%)患者出现远期尿失禁程度加剧。在所有患者中Grade≥2级的GU和GI的近期AEs分别为5例(5.9%)和7例(8.2%),远期AEs分别为8例(9.4%)和9例(10.6%)。患者的5年无生化进展生存率、无远处转移生存率、总生存率和癌症特异性生存率分别为71.8%、85.9%、89.4%和95.3%。结论:SRT治疗RP后出现BCR或LRD的局限性高危前列腺癌患者具有良好的临床疗效及较少的近期和远期AEs。SRT治疗对控尿功能的恢复没有显著影响。Objective Clinically localized high-risk prostate cancer patients with biochemical recurrence(BCR)or local recurrent disease(LRD)after radical prostatectomy(RP)usually receive salvage radiotherapy(SRT)treatment.This article studied the clinical efficacy of patients with localized high risk prostate cancer who developed BCR or LRD after RP and were followed with SRT and its potential impact on urinary incontinence recovery.Methods The clinical efficacy and its potential impact on urinary incontinence recovery of patients with localized high risk prostate cancer who developed BCR or LRD after RP treatment and were followed with SRT in Second Affiliated Hospital of Hainan Medical University from September 2006 to September 2018 were retrospectively analyzed.The primary endpoint was the urinary incontinence rate(UIR).The secondary endpoints were biochemical failure-free survival,distant metastasis-free survival,disease specific survival,and total overall survival.In addition,short-term(90 days)and long-term(after 90 days)adverse events(AEs)to the gastrointestinal(GI)and genitourinary(GU)systems due to radiotherapy were also included in the analysis.Results A total of 85 patients were included in the study.The median follow-up time was 86(24,152)months.Sixty-five patients(76.5%)had satisfactory urinary control before SRT.After receiving SRT,2(2.4%)and 3(3.5%)of the 65 patients had short-term and long-term CTCAE≥2 urinary incontinence,respectively.Among the remaining 20 patients(23.5%)who had symptoms of urinary incontinence before SRT,1 patient(1.2%)had recovered urine control in the short-and long-term after receiving SRT.The rest of 19(22.4%)patients have remained stable incontinence in the short-term,and 2(2.4%)patients have progressed long-term urinary incontinence.Among all patients,the short-term AEs of GI and GU systems with Grade≥2 were 5(5.9%)and 7(8.2%),and the long-term AEs were 8(9.4%)and 9(10.6%),respectively.The 5-year biochemical failure-free survival,distant metastasis-free survival,total overall s

关 键 词：局限性高危前列腺癌 根治性前列腺切除术 挽救性放疗 尿失禁 

分 类 号：R737.25[医药卫生—肿瘤]