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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

陈健 严维刚 李汉忠 纪志刚 周毅 周智恩 麦智鹏

陈健, 严维刚, 李汉忠, 纪志刚, 周毅, 周智恩, 麦智鹏. 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[J]. 协和医学杂志, 2016, 7(2): 104-109. doi: 10.3969/j.issn.1674-9081.2016.02.005
引用本文: 陈健, 严维刚, 李汉忠, 纪志刚, 周毅, 周智恩, 麦智鹏. 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[J]. 协和医学杂志, 2016, 7(2): 104-109. doi: 10.3969/j.issn.1674-9081.2016.02.005
Jian CHEN, Wei-gang YAN, Han-zhong LI, Zhi-gang JI, Yi ZHOU, Zhi-en ZHOU, Zhi-peng MAI. Effectiveness of Brachytherapy Combined with External Beam Radiation Therapy and Hormonal Therapy in Treating Localized High-risk Prostate Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2016, 7(2): 104-109. doi: 10.3969/j.issn.1674-9081.2016.02.005
Citation: Jian CHEN, Wei-gang YAN, Han-zhong LI, Zhi-gang JI, Yi ZHOU, Zhi-en ZHOU, Zhi-peng MAI. Effectiveness of Brachytherapy Combined with External Beam Radiation Therapy and Hormonal Therapy in Treating Localized High-risk Prostate Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2016, 7(2): 104-109. doi: 10.3969/j.issn.1674-9081.2016.02.005

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

doi: 10.3969/j.issn.1674-9081.2016.02.005
详细信息
    通讯作者:

    严维刚 电话:010-69152510, E-mail:ywgemailbox@sina.com

  • 中图分类号: R737.25

Effectiveness of Brachytherapy Combined with External Beam Radiation Therapy and Hormonal Therapy in Treating Localized High-risk Prostate Cancer

More Information
  • 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。
  • 图  1  132例前列腺癌患者的无生化复发生存率(A)、疾病特异性生存率(B)和总体生存率(C)

    CRPC:去势抵抗性前列腺癌

    图  2  按Gleason评分(A)、TNM分期(B)及手术前PSA水平(C)分组患者的无生化复发生存率

    PSA:同表 1

    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
    下载: 导出CSV

    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
    bPFS
    (%)
    CSS
    (%)
    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 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
    下载: 导出CSV

    表  3  前列腺癌预后及生存相关因素分析P

    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
    下载: 导出CSV
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  • 收稿日期:  2014-04-30
  • 刊出日期:  2016-03-30

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