“超级主动监测”治疗策略:局限低危前列腺癌的临床初步应用评价  

"Super-active surveillance" treatment strategy:preliminary clinical application evaluation of localized low-risk prostate cancer

作　　者：崔亮[1] 付春龙 赵鉴明 张讯[1] 代晓飞 刘亚超[2] 王淼 刘明[3] 李景敏[1] CUI Liang;FU Chunlong;ZHAOJ ianming;ZHANG Xun;DAI Xi-aofei;LIU Yachao;WANG Miao;LIU Ming;LI Jingmin(Department of Urology,Civil Aviation General Hospital,Civil Aviation Medical Collegeo f Peking University,Beijing 100123,China;不详)

机构地区：[1]北京大学民航临床医学院民航总医院泌尿外科,北京100123 [2]中国人民解放军总医院核医学科 [3]北京医院泌尿外科、国家老年医学中心、中国医学科学院老年医学研究院

出　　处：《现代泌尿生殖肿瘤杂志》2024年第5期270-275,共6页Journal of Contemporary Urologic and Reproductive Oncology

基　　金：民航医学中心(民航总医院)一般项目(202214);中国医学科学院中央级公益性科研院所基本科研业务费-第二届中国健康长寿创新大赛项目(2021-JKCS-022)。

摘　　要：目的应用多模态医学影像联合术中图像融合技术,精准靶向局灶冷冻消融治疗低危前列腺癌,探索“超级主动监测”治疗策略的临床应用价值。方法回顾性分析2018年10月至2020年12月北京地区于民航总医院接受超级主动监测(较传统“主动监测”治疗模式更为积极的治疗模式)的7例局限低危前列腺癌患者的临床资料。年龄中位值65(59~78)岁,治疗前PSA中位值8.11(5.02~9.83)ng/ml,前列腺体积中位值35.78(29.61~40.22)ml,术前国际前列腺症状评分(IPSS)中位值14(9~20),生活质量评分(QOL)中位值1(0~3)分,最大尿流率(Q_(max))中位值10.9(7.2~12.3)ml/s,尿失禁(ICI-Q-SF)评分均为0分,术前国际勃起功能问卷(IIEF-5)评分中位值13(0~18)。术前确诊病灶10处(单处病灶4例,2处病灶3例),术前穿刺病理提示均为腺癌,Gleason评分均为6(3+3)分,临床分期均为T_(2a)期7例。所有患者术前均行^(18)F-PSMAPET/MR检查,术前应用三维重建技术结合术中超声靶向穿刺融合软件完成术前规划标记,术中实时图像融合靶向精准冷冻消融病灶。术后监测血清PSA、PSMAPET/MRI和MRI评估肿瘤控制情况,采用IPSS评分、QOL评分、Q_(max)、ICI-Q-SF评分及IIEF-5评分评估功能学恢复情况。结果本组7例10处病灶,10处病灶全部进行靶向冷冻消融,手术时间中位值46(34~65)min。术后2~3d全部成功拔除尿管。中位随访时间24(12~42)个月,术后PSA较术前均明显下降。6例患者随访评价未出现肿瘤学进展,1例肿瘤学进展行再次局灶靶向冷冻消融治疗。7例患者QOL评分、ICI-Q-SF评分及IIEF-5评分与术前基本持平,5例患者IPSS评分、Q_(max)与术前基本持平。结论^(18)F-PS-MAPET/MR多模态核医学影像技术与术中超声实时融合精准靶向冷冻消融治疗局限低危前列腺癌的超级主动监测治疗模式,是在合理危险度分层基础上,结合患者健康状态和主观意愿所施行的更为积极的局灶治疗临床策略。Objective To explore the clinical application value of applying the multi-modal imaging combined with precise targeted focal cryoablation technology for "super-active surveillance" treatment strategy in localized low-risk prostate cancer.Methods The clinical data of 7 patients with localized low-risk prostate cancer who underwent super active monitoring in our hospital from October 2018 to December 2020 were analyzed retrospectively.The median age was 65(59-78) years,and the median PSA before treatment was 8.11(5.02-9.83) ng/ml.The median prostate volume was 35.78(29.61-40.22) ml,and the median preoperative International Prostate Symptom Score(IPSS) was 14(9-20).The median QOL score was 1(0-3),and the median maximum urinary flow rate(Qmax) was 10.9(7.2-12.3)ml/s.The median urinary incontinence(ICI-Q-SF) score was 0,and the median preoperative international erectile function questionnaire(IIEF-5) score was 13(0-18).Ten lesions were diagnosed before operation(1 lesion in 4 patients,2 lesions in 3 patients).Preoperative pathology showed that they were adenocarcinoma(Gleason score 3+3=6),with clinical stage of T2a in 7 patients.All patients underwent preoperative 18F-PAMA PET/MR multimodal nuclear medicine imaging.Preoperative 3-dimensional reconstruction technology combined with intraoperative ultrasound targeted puncture fusion software was used to complete the planning and marking before cryosurgery,and precise cryoablation was performed during operation.Serum PSA,18F-PSMA PET/MR and MRI were monitored after operation to evaluate the tumor control.IPSS score,QOL score,Qmax,ICI-Q-SF score and IIEF-5 score were used to evaluate the functional recovery.Results There were 10 lesions in 7 patients.All 10 lesions underwent cryoablation.The median operation time was 46 min(34-65) min.All patients were sucesslully removed indwelling of catheter after 2-3 days.The median follow-up time was 24(12-42) months.The postoperative PSA was significantly lower than that before operation.Six patients had no oncological progression.O

关 键 词：冷冻消融 前列腺癌 主动监测 局灶治疗 图像融合 

分 类 号：R737.25[医药卫生—肿瘤]