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Effectiveness of Brachytherapy Combined with External Beam Radiation Therapy and Hormonal Therapy in Treating Localized High-risk Prostate Cancer
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摘要:
目的 研究近距离治疗联合外放射治疗及内分泌治疗对局部高危前列腺癌的疗效。 方法 2003年12月至2007年12月北京协和医院泌尿外科收治前列腺癌近距离治疗患者132例, 其中局部高危患者97例, 局部中、低危患者35例。通过门诊随访, 监测患者术后血清前列腺特异性抗原(prostate specific antigen, PSA)水平, 记录患者出现生化复发、进展至去势抵抗性前列腺癌(castration-resistant prostate cancer, CRPC)或肿瘤远处转移、死亡等事件, 了解患者无生化复发生存率(biochemical progression-free survival, bPFS)、疾病特异性生存率(cause-specific survival, CSS)及总体生存率(overall survival, OS)。 结果 132例患者bPFS、CSS、OS分别为83.3%、91.7%、84.8%, 局部高危患者为81.4%、88.7%、81.4%, 局部低、中危患者为88.6%、100%、94.3%。局部高危患者bPFS及OS与局部低、中危患者相比差异无统计学意义(P=0.433, 0.098);而局部低、中危患者CSS明显高于局部高危患者(P=0.037)。按不同Gleason评分、TNM临床分期、术前PSA水平分别分组, 各组患者间bPFS差异均无统计学意义(P=0.084, 0.537, 0.850)。 结论 对于局部高危前列腺癌患者, 近距离治疗联合外放射治疗或内分泌治疗可有效控制PSA水平并延缓生化复发。 Abstract:Objective To evaluate the effectiveness of brachytherapy combined with external beam radiation therapy and hormonal therapy in treating localized high-risk prostate cancer patients. Methods We retrospectively analyzed 132 prostate cancer patients treated with brachytherapy from December 2003 to December 2007 in Department of Urology, Peking Union Medical College Hospital, including 97 localized high-risk patients, and 35 localized low- to intermediate-risk patients. Postoperative prostate specific antigen (PSA) level was monitored regularly in follow-up visits. Biochemical relapse, progression to castration-resistant prostate cancer (CRPC) or metastasis, and deaths were documented. Biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) of the patients were evaluated. Results The bPFS, CSS, and OS of the 132 patients were 83.3%, 91.7%, and 84.8%, respectively; those indexes of the 97 localized high-risk patients were 81.4%, 88.7%, and 81.4%, respectively; and those of the 35 localized low- to intermediate-risk patients were 88.6%, 100%, and 94.3%, respectively. No significant difference was observed in bPFS and OS between high-risk and low-to intermediate-risk patients (P=0.433, 0.098), while CSS was significant higher in low-to intermediate-risk patients than in high-risk patients (P=0.037). After patients were grouped based on Gleason score, tumor-node-metastasis (TNM) clinical stage, or preoperative PSA levels, differences in bPFS among groups were not statistically significant (P=0.084, 0.537, 0.850). Conclusion Brachytherapy combined with external beam radiation therapy and hormonal therapy may effectively control PSA level and delay biochemical relapse in localized high-risk prostate cancer. -
表 1 132例前列腺癌患者临床资料
项目 例数(%) 临床分期 T1~T2a 28(21.2) T2b 23(17.4) T2c~T3 81(61.4) PSA(μg/L) ＜10 28(21.2) 10~19.9 55(41.7) ≥20 49(37.1) Gleason评分 ≤6 41(31.1) 7 45(34.1) ≥8 46(34.8) 高血压 无 79(59.8) 有 53(40.2) 糖尿病 无 110(83.3) 有 22(16.7) 冠心病 无 106(80.3) 有 26(19.7) 内分泌治疗时间(月) 0 15(11.4) ≤6 36(27.3) ＞6 81(61.4) 外放疗 无 107(81.1) 有 25(18.9) 复合肺叶切除：肺叶+肺叶或肺叶+段切除；亚肺叶切除：肺楔形切除或解剖性肺段切除；*3例Ⅳ期患者为肿瘤胸膜腔播散 
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表 2 局部低、中危组与局部高危前列腺癌患者预后及生存比较
组别 是否复发 是否转移 是否死亡 否 是 bPFS
(%)否 是 CSS
(%)否 是 OS
(%)低、中危组 31 4 88.6 35 0 100 33 2 94.3 高危组 79 18 81.4 86 11 88.7 79 18 81.4 P值 0.433 0.037 0.098 bPFS：无生化复发生存率；CSS：疾病特异性生存率；OS：总体生存率
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表 3 前列腺癌预后及生存相关因素分析P值
影响因素 bPFS CSS OS 手术时年龄组 0.513 0.688 0.032 治疗前PSA 0.104 0.970 0.978 穿刺阳性比例 0.001 0.021 0.013 前列腺体积 0.250 0.210 0.103 D90(Gy) 0.167 0.560 0.235 T分期 0.010 0.472 0.229 是否联合外放疗 0.112 0.151 0.469 是否联合内分泌治疗 0.029 0.979 0.003 内分泌治疗时间 0.009 0.958 0.043 高血压 0.382 0.787 0.637 糖尿病 0.384 0.251 0.926 冠心病 0.627 0.149 0.915 Gleason评分 0.317 0.537 0.954 PSA:同表 1；bPFS、CSS、OS:同表 2
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