细胞减灭性根治性前列腺切除术在寡转移性前列腺癌患者中的疗效  

Efficacy of cytoreductive radical prostatectomy in patients with oligometastatic prostate cancer

作　　者：郑伟[1] 高闫尧 雷毅[1] 庄承霖 刘宁 窦小亮 Zheng Wei;Gao Yanyao;Lei Yi;Zhuang Chenglin;Liu Ning;Dou Xiaoliang(Department of Urology,the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang 712000,China;Department of Urology,the Second Affiliated Hospital of Air Force Military Medical University,Xi′an 710038,China;Department of Urology,Xi′an First Hospital,Xi′an 710018,China)

机构地区：[1]陕西中医药大学第二附属医院泌尿外科,咸阳712000 [2]空军军医大学第二附属医院泌尿外科,西安710038 [3]西安市第一医院泌尿外科,西安710018

出　　处：《国际外科学杂志》2025年第2期131-137,F0004,共8页International Journal of Surgery

摘　　要：目的探讨细胞减灭性根治性前列腺切除术(CRP)在寡转移性前列腺癌患者中的疗效,并评估其对无进展生存期(PFS)、总生存期(OS)及并发症发生率和严重程度的影响。方法采用前瞻性、单中心、非随机对照研究方法,选取2020年1月—2024年6月空军军医大学第二附属医院收治的80例寡转移性前列腺癌患者,分别分配至CRP组和无局部治疗(NLT)组,每组各40例。研究通过多变量分析调整潜在混杂因素,评估CRP对PFS、OS及生物标志物[如循环肿瘤细胞(CTC)、DNA甲基化状态]的影响。同时,记录并发症发生率及严重程度。计量资料以均数±标准差(±s)表示,组间比较采用t检验;计数资料和等级资料以例数和百分比[例(%)]表示,组间比较采用χ2检验。采用Kaplan-Meier法计算PFS和OS,组间差异比较采用Log-rank检验。使用Cox比例风险回归模型进行多变量分析。采用时间依赖的Cox回归模型进行分析,以考虑随访时间对结果的影响。结果CRP组的PFS和OS均显著优于NLT组。CRP组和NLT组在12个月时PFS率分别为60%和35%(P=0.030)。CRP组的OS率在12个月时达到80%,而NLT组为50%(P=0.040)。CRP组的CTC水平从第1个月的50个/mL下降至第12个月的5个/mL,DNA甲基化状态从第1个月的0.75下降至第12个月的0.30,均显著优于NLT组(P<0.05)。并发症发生率在第1个月至第12个月逐渐降低,CRP组从30%降至10%,NLT组从25%降至12%(P=0.080)。尽管CRP组在早期的并发症严重程度略高于NLT组,但随访至第12个月时,两组的并发症严重程度差异逐渐缩小,最终趋于相似。结论CRP在寡转移性前列腺癌患者中显著延长了PFS和OS,降低了肿瘤负荷,尽管早期并发症发生率较高,但总体安全性良好。Objective To investigate the efficacy of cytoreductive radical prostatectomy(CRP)in patients with oligometastatic prostate cancer,and to assess its impact on progression-free survival(PFS),overall survival(OS),as well as the incidence and severity of complications.Methods A prospective,monocentric non-randomized controlled trial including 80 cases of oligometastatic prostate cancer admitted to the Second Affiliated Hospital of Air Force Military Medical University from January 2020 to June 2024 was conducted.There were 40 patients each assigned to CRP group and no local treatment(NLT)group.The study used multivariate analysis to account for potential biases,analyzed the effects of CRP on PFS,OS as well as circulating tumor cell(CTC)and DNA methylation status.Meanwhile,the incidence and severity of complications were recorded.Measurement data were expressed as mean±standard deviation(±s),and t-test was used for inter-group comparison.Count data and rank data were expressed as number of cases and percentage,and Chi-test was used for comparison between groups.Kaplan-Meier method was used to calculate PFS and OS,and Log-rank test was used to compare differences between groups.Multivariate analysis was performed using Cox proportional hazard regression model.A time-dependent Cox regression model was used to consider the effect of follow-up time on the results.Results The PFS and OS in the CRP group were significantly better than those in the NLT group.The PFS rates in CRP group and NLT group at 12 months were 60%and 35%(P=0.030).The OS rates at 12 months in the CRP group reached 80%,compared to 50%in the NLT group(P=0.040).The level of CTC in the CRP group decreased from 50 cells/mL at first month to 5 cells/mL at 12th month,and the DNA methylation status decreased from 0.75 at first month to 0.30 at 12th month,which were significantly better than those in the NLT group(P<0.05).The incidence of complications decreased gradually from first month to 12th month,with the CRP group from 30%to 10%,and the NLT group from 2

关 键 词：寡转移性前列腺癌 细胞减灭性根治性前列腺切除术 无进展生存期 总生存期 

分 类 号：R73[医药卫生—肿瘤]