前列腺癌根治术联合新辅助内分泌治疗T3bNOMO期前列腺癌的疗效分析

发布时间：2018-03-14 18:01

  本文选题：前列腺癌根治术　切入点：新辅助内分泌治疗　出处：《山东大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的 探讨根治性前列腺切除术联合术前新辅助内分泌治疗T3bN0M0期前列腺癌的治疗效果和安全性。 材料和方法 通过回顾性总结分析自2008年1月至2013年5月,山东省立医院泌尿外科共收治136例T3bN0M0前列腺癌患者的病例资料,根据治疗方式的不同可分为以下三组,NHT组：耻骨后前列腺癌根治术联合术前3个月新辅助内分泌治疗(MAB)的患者54例；RP组：术前诊断为cT2期而行耻骨后根治性前列腺切除术,手术之后病理学检查发现为T3b期的患者38例；MAB组：未行根治术而单纯行内分泌治疗(MAB)的患者44例,NHT组与RP组术后均继续接受内分泌治疗(MAB)。治疗前三组患者的基本情况(年龄、前列腺体积、PSA水平、Gleason评分)的差异无统计学意义(P0.05),通过对比分析NHT组与RP组患者的手术时间、失血量、切缘阳性率,术后尿管留置时间、患者控尿恢复时间、术后并发症发生率,及通过电话随访、家访或定期门诊复查等随访方式比较新辅助内分泌治疗对前列腺癌根治手术的影响,比较三组患者的2年及5年无生化复发生存率、无局部复发生存率、疾病特异性生存率以及总生存率。 结果 NHT组及RP组患者手术均获成功,NHT组和RP组的平均手术时间为(102.22±16.55)min和(96.03±17.80)min(P=0.378),术中平均失血量分别为(283.33±50.53)ml和(325.26±75.45)ml(P=0.022),术后切缘阳性率分别为20.37%和36.84%(P=0.08),术后平均尿管留置时间分别为(16.72±7.39)d和(17.34±6.49)d(P=0.678),三组患者随访(15-60个月)平均(40.65±14.40)月,除3例患者术后出现尿失禁外(NHT组2例、RP组1例),其余平均控尿恢复时间分别为(55.67±13.72)d和(60.84±15.17)d(P=0.01),NHT组术后出现尿道狭窄2例(3.7%),切口感染1例(1.9%),脂肪液化2例(3.7%),尿失禁2例(3.7%),其余无其他明显并发症,RP组术后出现尿道狭窄1例(2.6%),尿失禁1例(2.6%)、淋巴漏1例(2.6%)、切口感染1例(2.6%)、直肠损伤2例(5.2%)。NHT、RP和MAB组2年及5年的无生化复发率分别为(96.3%、87.04%)、(89.48%、68.43%)和(90.91%、70.46%)(2年P=0.104、5年P=0.036),NHT和RP组2年和5年的无局部复发率分别为(100%、96.30%)、和(97.37%、86.85%)(2年P=0.364、5年P=0.025),三组2年疾病特异性生存率均为100%,5年疾病特异性生存率则分别为98.15%、86.84%和84.10%(P=0.028),5年整体生存率分别为94.44%、84.21%和81.82%(P=0.099)。 结论 前列腺癌根治术联合术前新辅助内分泌治疗T3bN0M0期前列腺癌是安全可行的,不增加手术风险,并可适当减少术中失血量。新辅助内分泌治疗能够缩小前列腺体积、降低PSA水平,可以减少肿瘤切缘阳性率(特别是对于Gleason评分≤7的前列腺癌病例)并显著提升患者5年无生化复发生存率、无局部复发生存率以及疾病特异性生存率,远期效果佳。
[Abstract]:Purpose. To evaluate the efficacy and safety of radical prostatectomy combined with preoperative neoadjuvant endocrine therapy for stage T 3 N 0 M 0 prostate cancer. Materials and methods. From January 2008 to May 2013, 136 patients with T3bN0M0 prostate cancer were treated in Department of Urology, Shandong Provincial Hospital. According to the different treatment methods, 54 patients with retropubic prostate cancer treated with radical resection of retropubic prostate cancer combined with preoperative neoadjuvant endocrine therapy were divided into the following three groups: group RP: radical posterior pubic prostatectomy diagnosed as cT2 stage before operation. After operation, 38 patients with stage T3b were diagnosed as MAB group: 44 patients in NHT group and RP group continued to receive endocrine therapy after operation without radical operation but only with endocrine therapy. The basic condition (age, age, age) of the first three groups of patients (age, age, age, age, age, age, age, age, age, age, age, age, age, and age) of the three groups continued to receive endocrine therapy after surgery. There was no significant difference in PSA level and Gleason score between NHT group and RP group. The time of operation, the amount of blood loss, the positive rate of incision margin, the time of indwelling urethral catheter after operation, and the time of recovery of controlled urine were compared between NHT group and RP group. The incidence of postoperative complications and the effects of neoadjuvant endocrine therapy on radical prostatectomy were compared by telephone follow-up, home visit or regular outpatient reexamination. The 2-year and 5-year survival rates of the three groups were compared. Local recurrence free survival rate, disease specific survival rate and overall survival rate. Results. The average operative time of successful operation in NHT group and RP group was 102.22 卤16.55 min and 96.03 卤17.80 min / min respectively. The average blood loss during operation was 283.33 卤50.53 ml and 325.26 卤75.45 ml P0.022, respectively. The positive rate of incision margin was 20.37% and 36.844.45 ml P0.08 respectively. The mean time of indwelling urinary catheter after operation was 16.72 卤7.39 days and 16.72 卤7.39 days, respectively. The patients in the three groups were followed up for 15-60 months (mean 40.65 卤14.40 months). With the exception of 3 patients with urinary incontinence, 2 patients in the NHT group had urinary incontinence and 1 patient in the RP group, the average recovery time of urinary control was 55.67 卤13.72 days and 60.84 卤15.17 dP0. 01 in the NHT group respectively. Urethral stricture occurred in 2 cases, incision infection in 1 case, fat liquefaction in 2 cases, urinary incontinence in 2 cases, urinary incontinence in 2 cases, urinary incontinence in 2 cases and urethral stricture in 2 cases. In the RP group, there were 1 case of urethral stricture, 1 case of urinary incontinence, 1 case of lymphatic leakage, 1 case of incision infection, 2 cases of rectal injury, and 2 cases of rectal injury. The non-biochemistry recurrence rates for 2 years and 5 years in the RP and MAB group were 96.37.04 and 89.68.43, respectively. The non-local recurrence rates of NHT and RP were 96.30% and 86.85% (2 years P0. 364, 5 years P0. 025), respectively. The specific survival rates of the three groups were 100, 98.1586.84% and 84.10% respectively, and the overall survival rates of 5 years were 94.4484.21% and 81.82% P0.099%, respectively, and the survival rates of 5 years were 98.1586.84% and 84.10% P0.0280.The overall survival rates of 5 years were 94.444.21% and 81.822P 0.099%, respectively. The specific survival rates of the three groups were 100, and the 5-year disease specific survival rates were 98.1586.84% and 84.10% P0.0280.The overall survival rates for 5 years were 94.4484.21% and 81.822% respectively. Conclusion. Radical resection combined with preoperative neoadjuvant endocrine therapy for stage T3bN0M0 prostate cancer is safe and feasible, does not increase the risk of operation, and can appropriately reduce intraoperative blood loss. Neoadjuvant endocrine therapy can reduce prostate volume and PSA level. It can reduce the positive rate of tumor margin (especially for prostate cancer with Gleason score 鈮，

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