高危前列腺癌术后辅助放射治疗的研究进展  

Research progress in adjuvant radiotherapy in the postoperative management of high-risk prostate cancer

作　　者：李沅霖 李明焕 Li Yuanlin;Li Minghuan(School of Clinical Medicine,Shandong Second Medical University,Weifang 261053,China;Department of Abdominal Radiotherapy,Shandong First Medical University Afiliated Tumor Hospital,Jinan 250117,China)

机构地区：[1]山东第二医科大学临床医学院,潍坊261053 [2]山东第一医科大学附属肿瘤医院腹部放疗科,济南250117

出　　处：《中华放射肿瘤学杂志》2024年第12期1158-1163,共6页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金面上项目(82172677)。

摘　　要：大约30%~40%的前列腺癌手术患者将经历生化复发,而在高危局部晚期的患者中,这一比例为50%~70%。根据3项随机对照试验的结果,与主动监测相比,对于具有前列腺包膜外侵、精囊腺浸润、高Gleason评分或阳性切缘等不良病理特征的高危患者,前列腺术后辅助放疗(ART)可使其生化复发风险减少约50%。近期发表的3项高危前列腺癌患者术后挽救性放疗(SRT)与ART的对比研究中,SRT组的无事件生存期、临床和放射学进展情况与ART组相当,同时SRT组在泌尿系统和肠道等方面的不良反应相较于ART组有明显减少。然而,这些研究入组的人群不良特征异质性较大,在真实世界中还常见多项高危特征并存以及术后盆腔淋巴结转移的患者。因此,需要对不良特征进行个体化分析,以便筛选出可能从术后ART获益的患者,并尽可能减少放疗带来的不良反应,从而在提高患者生存率的同时保障其生活质量。Approximately 30%-40%of prostate cancer patients undergoing surgical treatment will experience biochemical recurrence.However,this proportion will be increased to 50%-70%among those with locally advanced,high-risk disease.In contrast to the approach of active surveillance,adjuvant radiotherapy(ART)administered after prostate surgery has demonstrated a substantial reduction of approximately 50%in the risk of biochemical recurrence among high-risk patients exhibiting adverse pathological characteristics such as extraprostatic extension,seminal vesicle invasion,a high Gleason score,or positive surgical margins.This conclusion is firmly supported by the results of three prior randomized controlled trials.In three recently published comparative studies,salvage radiation therapy(SRT)and ART were rigorously compared among patients with high-risk prostate cancer who had undergone surgical treatment.The results revealed that the early SRT cohort exhibited comparable rates of event-free survival,clinical outcomes,and radiological progression to those observed in the ART group.Notably,the SRT group reported significantly fewer adverse effects related to urinary and bowel functions,suggesting a more favorable safety profile compared to the ART group.However,there is substantial heterogeneity among the enrolled patient populations across these studies,exhibiting unfavorable characteristics.In real-world settings,we frequently encounter patients with multiple high-risk characteristics and those who have developed pelvic lymph node metastasis postoperatively.Given this,it is imperative to undertake an individualized analysis of these adverse features,which will enable us to precisely identify patients who are most responsive to postoperative ART while effectively mitigating radiotherapy-related adverse effects.Consequently,an improvement can be obtained in patient survival rates while also ensuring their quality of life.

关 键 词：前列腺肿瘤 外科手术 放射疗法 肿瘤复发 生活质量 

分 类 号：R737.25[医药卫生—肿瘤] R730.55[医药卫生—临床医学]