晚期前列腺癌行根治性切除术与内分泌治疗临床效果的比较

发布时间：2018-01-06 07:27

本文关键词：晚期前列腺癌行根治性切除术与内分泌治疗临床效果的比较　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：前列腺癌是男性泌尿生殖系统最常见的恶性肿瘤之一,其癌症死亡率仅次于支气管肺癌和结直肠癌。可疑前列腺癌的主要筛选方式是直肠指诊和前列腺特异性抗原检查,前列腺癌确诊需要前列腺穿刺活检的病理检查。晚期前列腺癌的主要治疗手段包括内分泌治疗、化疗、放疗及免疫治疗,治疗效果欠佳,部分患者可发展为去势抵抗性前列腺癌,增加治疗难度。前列腺癌根治性切除术作为晚期前列腺癌的减瘤手术,目前缺乏治疗有效的高级证据,故诊疗指南尚未推荐对晚期前列腺癌患者行前列腺癌根治性切除术。由于理论、前期临床试验效果观察及手术水平的提高,现在有必要进一步探讨晚期前列腺癌根治性切除术的效果。目的:探讨晚期前列腺癌患者行晚期前列腺癌行根治性切除术与内分泌治疗临床效果,为晚期前列腺癌的手术治疗提供理论依据。方法:回顾分析山东省立医院泌尿微创中心2012年01月至2017年03月期间,确诊为晚期前列腺癌,行内分泌治疗或者前列腺癌根治性切除术,具有完整临床资料的患者共135例,随访12个月,统计分析患者前列腺特异性抗原及睾酮的变化。运用SPSS 20.0软件分析进行数据分析统计。计量资料以均数±标准差表示,用t检验或方差分析。分类资料进行卡方检验。可信区间为95%,P0.05为差异具有统计学意义。结果：本研究纳入晚期前列腺癌患者共计135例,行前列腺癌根治性切除术者70例,行内分泌治疗者65例。前列腺癌根治性切除术组的年龄、总前列腺特异性抗原、游离/总前列腺特异性抗原及碱性磷酸酶高于内分泌组,两者之间的差异存在统计学意义。前列腺癌根治性切除术患者术后第1月、3月、6月、12月总前列腺特异性抗原和游离前列腺特异性抗原较内分泌治疗组低,两者的差异具有统计学意义,但是两组患者的游离前列腺特异性抗原在第12月不存在统计学意义上的差异。前列腺癌根治性切除术后第1月、3月、6月、12月,血清总前列腺特异性抗原和游离前列腺特异性抗原降至正常水平的病例高于内分组治疗组。前列腺癌根治性切除术患者术后第1月、3月、6月、12月游离/总前列腺特异性抗原较内分泌治疗组低,但两者的差异不具有统计学意义。前列腺癌根治性切除术后第3月、6月、12月,血清游离/总前列腺特异性抗原降至正常水平的病例高于内分组治疗组。前列腺癌根治性切除术患者术后第1月、3月、6月、12月睾酮较内分泌治疗组高,第1月、3月、6月两者的差异具有统计学意义,第12月不存在统计学意义上的差异。结论:与内分泌治疗相比,前列腺癌根治性切除术可以短期内降低晚期前列腺癌患者血清总前列腺特异性抗原、游离前列腺特异性抗原的水平,而两者之间游离/总前列腺特异性抗原不存在明显差异,同时睾酮降低水平不如内分泌治疗。此外,与内分泌治疗相比,前列腺癌根治性切除术可以将大部分患者的前列腺特异性抗原降至正常水平。
[Abstract]:Prostate cancer is one of the most common malignant tumor in male genitourinary system, the cancer mortality after lung cancer and colorectal cancer. The main way of screening of suspected prostate cancer is rectal examination and prostate-specific antigen examination, pathological examination of prostate cancer diagnosis requires a biopsy of the prostate. The main treatment of advanced prostate cancer include endocrine therapy. Chemotherapy, radiotherapy and immunotherapy, poor treatment, some patients may develop a castration resistant prostate cancer, increase the difficulty of treatment of prostate cancer. Radical resection as cytoreductive surgery for advanced prostate cancer, the current lack of effective treatment of advanced evidence, the guidelines do not recommend to patients with advanced prostate cancer prostate cancer after radical resection operation. Because of theory, the preliminary clinical trial results and improve the level of operation, it is necessary to further To investigate the effect of radical resection of advanced prostate cancer. Objective: To investigate the resection and clinical effect of endocrine therapy in patients with advanced prostate cancer patients with advanced prostate cancer who underwent radical surgery, and provide a theoretical basis for the treatment of advanced prostate cancer. Methods: Shangdong Province-owned Hospital minimally invasive urology center in 2012 01 to 2017 03 months were retrospectively analyzed during diagnosed late prostate cancer, endocrine therapy or prostate cancer radical resection, with complete clinical data of patients with a total of 135 cases were followed up for 12 months, changes in statistical analysis of patients with prostate specific antigen and testosterone. Analysis of data were analyzed by using SPSS 20 statistical software. Measurement data to mean + standard deviation, t test or analysis of variance. The classification data by chi square test. The confidence interval is 95% P0.05, the difference was statistically significant. Results: the study included the forefront of late A total of 135 cases of patients with adenocarcinoma of prostate cancer, radical resection in 70 cases, 65 cases underwent endocrine therapy. The age of radical resection group of prostate cancer, prostate specific antigen, free / total prostate-specific antigen and alkaline phosphatase was higher than that of endocrine group, statistically significant differences between the two. First months after radical resection, postoperative patients with prostate cancer in March, June, December, total prostate-specific antigen and free prostate-specific antigen with endocrine therapy group, the difference was statistically significant, but the two groups of patients with free prostate specific antigen in twelfth months there is no statistically significant difference in the cure. For first months after operation of prostate cancer in March, June, December, serum total prostate specific antigen and free prostate-specific antigen to normal levels were higher than in the group of prostate treatment group. Cancer resection patients first months after March, June, December free / total prostate-specific antigen is endocrine therapy group, but the difference was not statistically significant. Radical resection in third months after operation of prostate cancer in June, December, serum free / total prostate-specific antigen decreased to normal level in the group were higher than the treatment group. First months after radical resection, postoperative patients with prostate cancer in March, June, December is testosterone endocrine therapy group, first month, March, the difference was statistically significant between the twelfth month of June, there was no statistical difference significance. Conclusion: compared with endocrine therapy, resection short term operation can reduce the total serum prostate specific antigen in patients with advanced prostate cancer to cure prostate cancer, free prostate specific antigen levels, and between the two free / total prostate-specific antigen is not significantly different, At the same time, testosterone level is lower than endocrine therapy. In addition, compared with endocrine therapy, radical prostatic resection can reduce most patients' prostate specific antigen to normal level.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.25

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