综合治疗中晚期前列腺癌的远期疗效分析  

Long-term results of endocrinotherapy and(or) radiotherapy for moderately and far advanced prostate cancer

作　　者：周桂霞[1] 张磊[2] 曾狄闻[1] 王晓雄[2] 杨东[1] 

机构地区：[1]解放军总医院放疗科,北京00853 [2]解放军总医院泌尿外科,北京00853

出　　处：《中华泌尿外科杂志》2003年第8期548-551,共4页Chinese Journal of Urology

摘　　要：目的　总结综合治疗中晚期前列腺癌的远期疗效。　方法　 2 5 6例前列腺癌患者 ,C期 182例 ,D期 74例。腺癌 2 36例 ,鳞癌 7例 ,未分化癌 13例。Gleason评分 >6分者 2 0 2例。采用双睾切除加内分泌治疗和 (或 )放射治疗。　结果　 2 36例 (92 .2 % )患者PSA在短期内迅速下降至 2ng/ml以下 ;总 5、10、15年生存率为 4 8.8%、2 9.7%和 13.3% ,其中C期为 5 8.2 %、38.4 %和 17.7% ,D期为 2 5 .7%、6 .4 %和 0 ;C期与D期 5年与 10年生存率差异有显著性意义 (P <0 .0 0 5 ) ;照射剂量<70Gy者 5、10、15年生存率分别为 39.7%、7.7%、0 % ,≥ 70Gy者分别为 5 5 .9%、4 4 .1%和 2 1.6 % ,5年和 10年生存率差异有显著性意义 (P <0 .0 5 )。　结论　综合治疗是中晚期前列腺癌的主要治疗方法 ,临床分期、Gleason分级、照射剂量是影响长期生存的主要因素。Objective To study the longterm result of endocrinotherapy and (or) radiotherapy for moderately and far advanced prostate cancer. Methods 256 cases of moderately or far advanced prostate cancer were treated with endocrinotherapy (surgical castration + postoperative drug administration) and (or) radiotherapy.182 cases were of stage C and 74 stage D.There were 236 adenocarcinoma,7 squamous cancer and 13 undifferentiated cancer.Gleason score was ≥6 in 202 patients and 134 had pelvic lymphoid metastasis. Results In 92.2%of the patients,the serum PSA dropped under 2 ng/ml shortly after the treatment.The overall 5,10,15 year survival rates were 48.8%,29.7% and 13.3% respectively.For stage C cases,these were 58.2%,38.4%,17.7% and for stage D 25.7%,6.4%,0.The 5 and 10 year survival rates were significantly different between stage C and D(P<0.005).In patients underwent radiotherapy,when the dose was<70 Gy,the 5,10,15 year survival rates were 39.7%,7.7%,0;these were 55.9%, 44.1% and 21.6% when the dose was≥70 Gy(P<0.005). Conclusions The combined use of endocrinotherapy and radiotherapy is the treatment of first choice for moderately and far advanced prostate cancer.The main factors affecting the long term survival were the clinical stage of the tumor,the Gleason score and the irradiation dose.

关 键 词：前列腺癌 综合治疗 双侧睾丸切除术 放射治疗 内分泌治疗 

分 类 号：R737.25[医药卫生—肿瘤] R730.58[医药卫生—临床医学]