根治性前列腺切除术前行长期新辅助激素治疗：5年随访时生化复发风险评估

Long-term neoadjuvant hormone therapy prior to radical prostatectomy: evaluation of risk for biochemical recurrence at 5-year follow-up.

作者信息

Gleave M E, La Bianca S E, Goldenberg S L, Jones E C, Bruchovsky N, Sullivan L D

机构信息

Division of Urology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada.

出版信息

Urology. 2000 Aug 1;56(2):289-94. doi: 10.1016/s0090-4295(00)00627-0.

DOI:10.1016/s0090-4295(00)00627-0

PMID:10925096

Abstract

OBJECTIVES

To assess the effects of 8 months of neoadjuvant therapy on pathologic stage and biochemical recurrence rates.

METHODS

One hundred fifty-six men with clinically localized prostate cancer were treated with neoadjuvant combined androgen withdrawal therapy for 8 months prior to radical prostatectomy. Preoperative clinical stage, Gleason score, and serum prostate-specific antigen (PSA) levels were compared with treatment outcome (pathologic stage and PSA recurrence).

RESULTS

PSA at diagnosis was 10 microg/L or higher in 36% with a mean of 11.5 microg/L. Clinical stage was T1c in 18%, T2 in 74%, and T3a in 8%. Gleason score was 6 or lower in 76% and 7 or higher in 24%. Pathologic stage was T0 in 13%, T2 in 66%, T3 (specimen confined) in 13%, T3 (margin positive) in 6%, and TxN+ in 2%. Incidence of positive margins increased with clinical stage T3a versus organ-confined disease (25% versus 4%, P <0.05), pretreatment Gleason scores 7 or higher versus Gleason scores 6 or lower (11% versus 4%, P = NS), and pretreatment PSA levels higher than 10 microg/L compared with PSA levels lower than 10 microg/L (15% versus 0%, P <0.01). Overall PSA recurrence rate was 12.2% after a mean postoperative follow-up of 54 months. Risk of PSA recurrence increased with clinical stage (25% T3 versus 11% organ confined, P <0.01), pretreatment PSA (7% if PSA lower than 10 microg/L versus 21% if 10 microg/L or higher, P <0.02), Gleason score (9% if 6 or lower versus 22% if 7 or higher, P <0.02), and pathologic stage (6% of pT2, 24% of pT3M-, and 56% of pT3M+, P <0.01). PSA recurrences occurred in 6% of patients with no adverse preoperative risk factors, 12% with any one of the high-risk factors, and 29% with any two of the high-risk factors.

CONCLUSIONS

Risk of PSA recurrence after 8 months of neoadjuvant therapy is low after 5 years of follow-up and remains proportional to the presence of adverse preoperative risk factors. Prospective randomized studies are required to determine whether longer duration of neoadjuvant therapy reduces the risk of biochemical recurrence after radical prostatectomy.

摘要

目的

评估8个月新辅助治疗对病理分期及生化复发率的影响。

方法

156例临床局限性前列腺癌男性患者在根治性前列腺切除术前行8个月新辅助联合雄激素剥夺治疗。将术前临床分期、Gleason评分及血清前列腺特异性抗原（PSA）水平与治疗结果（病理分期及PSA复发情况）进行比较。

结果

诊断时PSA为10μg/L或更高者占36%，平均为11.5μg/L。临床分期T1c占18%，T2占74%，T3a占8%。Gleason评分6分及以下者占76%，7分及以上者占24%。病理分期T0占13%，T2占66%，T3（标本局限）占13%，T3（切缘阳性）占6%，TxN+占2%。切缘阳性发生率在临床分期为T3a与器官局限性疾病者之间（25%对4%，P<0.05）、术前Gleason评分7分及以上与6分及以下者之间（11%对4%，P=无统计学意义）、术前PSA水平高于10μg/L与低于10μg/L者之间（15%对0%，P<0.01）存在差异。术后平均随访54个月，总体PSA复发率为12.2%。PSA复发风险随临床分期（T3期为25%，器官局限性为11%，P<0.01）、术前PSA（PSA低于10μg/L时为7%，10μg/L或更高时为21%，P<0.02）、Gleason评分（6分及以下时为9%，7分及以上时为22%，P<0.02）及病理分期（pT2为6%，pT3M-为24%，pT3M+为56%，P<0.01）升高。无术前不良风险因素的患者中PSA复发率为6%，有任何一项高危因素的患者中为12%，有任何两项高危因素的患者中为29%。