Ghavamian R, Bergstralh E J, Blute M L, Slezak J, Zincke H
Department of Urology, Mayo Clinic, Rochester, Minnesota 55902, USA.
J Urol. 1999 Apr;161(4):1223-7; discussion 1227-8.
Untreated stage pTxN+ prostate cancer is associated with a poor outcome. Monotherapy (surgery, radiation, hormonal therapy) alone is associated with a high progression rate. We evaluate whether radical prostatectomy and pelvic lymphadenectomy plus early adjuvant orchiectomy impart a survival advantage compared to pelvic lymphadenectomy and orchiectomy alone in a matched cohort of patients.
Between 1966 and 1995, 382 and 79 patients with stage pTxN+ prostate cancer underwent pelvic lymphadenectomy and radical prostatectomy plus early adjuvant orchiectomy (within 3 months of prostatectomy), and pelvic lymphadenectomy and orchiectomy only, respectively. We selected 79 matched controls from the prostatectomy plus orchiectomy group for the orchiectomy group. Patients were matched according to the number of positive nodes, clinical grade, clinical stage, age, year of surgery and preoperative prostate specific antigen (after 1987). The Kaplan-Meier method and stratified Cox proportional hazards model were used to estimate overall and cause specific survival for the 2 groups.
There was an overall survival advantage at 10 years for the prostatectomy plus orchiectomy (66+/-6%) compared to the orchiectomy (28+/-6%) group (p <0.001, risk ratio 0.36, 95% confidence interval 0.20 to 0.66). There was also an advantage in cause specific survival at 10 years in the prostatectomy plus orchiectomy (79+/-5%) versus the orchiectomy (39+/-7%) group (p <0.001, relative risk 0.28, 95% confidence interval 0.13 to 0.59). After 1987, when matched on preoperative prostate specific antigen, the apparent survival advantage at 5 years with radical prostatectomy was smaller (79+/-8 versus 63+/-9% orchiectomy) and not significant (p = 0.19).
This retrospective study of patients with stage pTxN+ PC suggests that radical prostatectomy with early adjuvant orchiectomy may provide a significant advantage in overall and cause specific survival compared to orchiectomy alone.
未经治疗的pTxN+期前列腺癌预后较差。单纯的单一疗法（手术、放疗、激素治疗）进展率较高。我们评估在一组匹配的患者中，与单纯盆腔淋巴结清扫术和睾丸切除术相比，根治性前列腺切除术、盆腔淋巴结清扫术加早期辅助睾丸切除术是否具有生存优势。
1966年至1995年间，分别有382例和79例pTxN+期前列腺癌患者接受了盆腔淋巴结清扫术、根治性前列腺切除术加早期辅助睾丸切除术（前列腺切除术后3个月内），以及仅接受盆腔淋巴结清扫术和睾丸切除术。我们从前列腺切除术加睾丸切除术组中为睾丸切除术组选取了79例匹配对照。根据阳性淋巴结数量、临床分级、临床分期、年龄、手术年份和术前前列腺特异性抗原（1987年后）对患者进行匹配。采用Kaplan-Meier法和分层Cox比例风险模型评估两组的总生存率和病因特异性生存率。
与睾丸切除术组（28±6%）相比，前列腺切除术加睾丸切除术组10年总生存率具有优势（66±6%）（p<0.001，风险比0.36，95%置信区间0.20至0.66）。前列腺切除术加睾丸切除术组10年病因特异性生存率也高于睾丸切除术组（79±5%对39±7%）（p<0.001，相对风险0.28，95%置信区间0.13至0.59）。1987年后，在根据术前前列腺特异性抗原进行匹配时，根治性前列腺切除术5年时的明显生存优势较小（79±8%对睾丸切除术的63±9%）且无统计学意义（p=0.19）。
这项对pTxN+期前列腺癌患者的回顾性研究表明，与单纯睾丸切除术相比，根治性前列腺切除术加早期辅助睾丸切除术在总生存率和病因特异性生存率方面可能具有显著优势。
