Ng Chee Kwan, Moussa Madeleine, Downey Donal B, Chin Joseph L
Division of Urology, Department of Pathology, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
J Urol. 2007 Oct;178(4 Pt 1):1253-7; discussion 1257. doi: 10.1016/j.juro.2007.05.137. Epub 2007 Aug 14.
We assessed the efficacy of cryoablation of the prostate with an emphasis on finding predictive factors that lead to improved outcome.
A total of 187 patients with locally recurrent prostate cancer after radiotherapy underwent salvage cryoablation of the prostate, and were studied after a mean followup of 39 months. Survival analysis was performed with the Kaplan-Meier method. Several variables were tested for predictive value using the Cox regression model including serum prostate specific antigen before radiotherapy, serum prostate specific antigen at cryoablation, clinical stage before radiotherapy, Gleason score before radiotherapy, Gleason score at cryoablation, number of positive biopsy cores and use of neoadjuvant hormonal therapy before cryoablation.
Serum prostate specific antigen at cryoablation was a predictive factor for biochemical recurrence on univariate and multivariate analysis (p <0.001). Patients with pre-cryoablation prostate specific antigen less than 4 ng/ml had a 5 and 8-year biochemical recurrence-free survival of 56% and 37%, respectively. In contrast, patients with pre-cryoablation prostate specific antigen 10 ng/ml or greater had a 5 and 8-year biochemical recurrence-free survival of only 1% and 7%, respectively. Patients with pre-cryoablation prostate specific antigen from 4 to 9.99 ng/ml had intermediate survival outcomes. Of the patients 32% were started on hormonal therapy for disease progression at a mean of 31 months postoperatively. Overall 5 and 8-year survival was 97% and 92%, respectively.
Salvage cryoablation is a viable treatment option for patients with prostate cancer in whom radiation therapy has failed. Salvage cryoablation should be performed when serum prostate specific antigen is still relatively low because in these patients the procedure may potentially be curative. Even when cryoablation fails to eradicate the disease in some patients, it allows hormonal therapy to be deferred for a significant period of time in that cohort.
我们评估了前列腺冷冻消融术的疗效，重点是寻找能改善预后的预测因素。
共有187例放疗后局部复发前列腺癌患者接受了挽救性前列腺冷冻消融术，并在平均随访39个月后进行研究。采用Kaplan-Meier法进行生存分析。使用Cox回归模型对多个变量进行预测价值测试，包括放疗前血清前列腺特异性抗原、冷冻消融时血清前列腺特异性抗原、放疗前临床分期、放疗前Gleason评分、冷冻消融时Gleason评分、阳性活检核心数量以及冷冻消融前新辅助激素治疗的使用情况。
冷冻消融时血清前列腺特异性抗原在单因素和多因素分析中均为生化复发的预测因素（p<0.001）。冷冻消融前前列腺特异性抗原低于4 ng/ml的患者，其5年和8年无生化复发生存率分别为56%和37%。相比之下，冷冻消融前前列腺特异性抗原为10 ng/ml或更高的患者，其5年和8年无生化复发生存率分别仅为1%和7%。冷冻消融前前列腺特异性抗原在4至9.99 ng/ml之间的患者生存结果居中。32%的患者在术后平均31个月时因疾病进展开始接受激素治疗。总体5年和8年生存率分别为97%和92%。
挽救性冷冻消融术是放疗失败的前列腺癌患者的一种可行治疗选择。当血清前列腺特异性抗原仍相对较低时应进行挽救性冷冻消融术，因为在这些患者中该手术可能具有潜在治愈性。即使在某些患者中冷冻消融术未能根除疾病，它也能使该队列中的激素治疗推迟相当长一段时间。
