Noguchi Masanori, Noda Shinshi, Nakashima Osamu, Kojiro Masamichi
Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Oncol Rep. 2002 Sep-Oct;9(5):1075-80.
The role of neoadjuvant hormonal therapy (NHT) before radical prostatectomy for localized prostate cancer remains controversial because many argue that apparent downstaging results in difficulties with the pathological evaluation of the neoadjuvant treated prostatectomy specimen. Furthermore, the downstaging to pT0 (no residual tumor), as reported by several institutions, remains questionable and is not yet confirmed by clinical or experimental evidence. To examine this issue and to assess the influence of NHT on downstaging, we investigated the stage pT0 status in radical prostatectomy specimens after NHT. We retrospectively reviewed 31 patients with histologically confirmed clinical stage T1c, T2 or T3 prostate cancer. All patients had received NHT for a mean duration of 5.2 months (range 2-19). We compared the pretreatment parameters (PSA, clinical stage, biopsy Gleason grade, number of positive cores, total length of cancer on each sextant biopsy or duration of NHT) to the pathological findings in the specimen sectioned at 3-mm thick after NHT. Five (16%) of 31 patients had no residual cancer (pT0) after radical prostatectomy, 8 (26%) had organ-confined disease (stage pT2), 6 (19%) had specimen confined disease, 10 (33%) had non-specimen confined disease and only 2 (6%) had lymph node metastasis. The histologic changes, including glandular atrophy and cytoplasmic vacuolation were stronger in specimens with a long duration (4 or more months) of NHT than those of a short duration (3 or less months). Multiple logistic regression analysis showed that only a longer duration of NHT was an independent predictor of a stage pT0 status in radical prostatectomy specimens after NHT (p=0.04, Odds ratio; 1.92, 95% CI; 1.03-3.56). Downstaging to pT0 occurs after duration of NHT of longer than 3 months. Further investigation of the optimal duration of NHT for downstaging and for improving patients' survival should be accomplished in randomized trials.
对于局限性前列腺癌，新辅助激素治疗（NHT）在根治性前列腺切除术之前的作用仍存在争议，因为许多人认为明显的降期会导致对接受新辅助治疗的前列腺切除标本进行病理评估时出现困难。此外，几家机构报告的降至pT0（无残留肿瘤）情况仍存在疑问，尚未得到临床或实验证据的证实。为了研究这个问题并评估NHT对降期的影响，我们调查了NHT后根治性前列腺切除标本中的pT0分期情况。我们回顾性分析了31例经组织学确诊为临床分期T1c、T2或T3前列腺癌的患者。所有患者均接受了平均时长为5.2个月（范围2 - 19个月）的NHT。我们将治疗前参数（前列腺特异性抗原（PSA）、临床分期、活检Gleason分级、阳性核心数量、每个象限活检的癌组织总长度或NHT时长）与NHT后切成3毫米厚的标本的病理结果进行了比较。31例患者中有5例（16%）在根治性前列腺切除术后无残留癌（pT0），8例（26%）有器官局限性疾病（pT2期），6例（19%）有标本局限性疾病，10例（33%）有非标本局限性疾病，只有2例（6%）有淋巴结转移。与NHT时长较短（3个月或更短）的标本相比，NHT时长较长（4个月或更长）的标本中包括腺体萎缩和细胞质空泡化在内的组织学变化更明显。多因素逻辑回归分析显示，在NHT后的根治性前列腺切除标本中，只有较长的NHT时长是pT0分期状态的独立预测因素（p = 0.04，比值比；1.92，95%可信区间；1.03 - 3.56）。NHT时长超过3个月后会出现降至pT0的情况。对于降期及改善患者生存率的NHT最佳时长，应通过随机试验进一步研究。
