根治性前列腺切除术联合即刻辅助雄激素剥夺治疗 pT3N0 前列腺癌的长期疗效。
Long-term results of radical prostatectomy with immediate adjuvant androgen deprivation therapy for pT3N0 prostate cancer.
机构信息
Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
出版信息
BMC Urol. 2014 Jan 29;14:13. doi: 10.1186/1471-2490-14-13.
BACKGROUND
Radical prostatectomy is used to treat patients with clinically localized prostate cancer, but there have been few reports of its use in locally advanced disease. We evaluated the long-term results of radical prostatectomy and immediate adjuvant androgen deprivation therapy in Japanese patients with pT3N0M0 prostate cancer.
METHODS
We retrospectively reviewed 128 patients with pT3N0M0 prostate cancer who underwent radical prostatectomy at our institute from 2000 to 2006. All pT3N0 patients were treated with adjuvant androgen deprivation therapy shortly after radical prostatectomy. Immediate adjuvant androgen deprivation therapy was continued for at least 5 years. Twenty-three were excluded because of preoperative hormonal therapy, missing data, or others. Death from any cause, death from prostate cancer, clinical recurrence and hormone-refractory biochemical progression were analyzed by Kaplan-Meier graphs. Relative risks of progression were estimated using Cox proportional hazards models with 95% confidence intervals.
RESULTS
The 10-year hormone-refractory biochemical progression-free survival rate was 88.3% and the cancer-specific survival rate was 96.3% after a median follow-up period of 8.2 years (range 25.6-155.6 months). Higher clinical stage (p = 0.013), higher Gleason score at biopsy (p = 0.001), seminal vesicle invasion (p = 0.003) and microlymphatic invasion (p = 0.006) were predictive factors for hormone-refractory biochemical progression by univariate analyses. Multivariate analyses identified Gleason score at biopsy (p = 0.027) and seminal vesicle invasion (p = 0.030) as independent prognostic factors for hormone-refractory biochemical progression. None of the patients with clinical T1 cancers (n = 20), negative surgical margin (n = 12), or negative perineural invasion (n = 11) experienced hormone-refractory biochemical progression.
CONCLUSIONS
Radical prostatectomy with immediate adjuvant androgen deprivation therapy may be a valid treatment option for patients with pT3N0M0 prostate cancer.
背景
根治性前列腺切除术用于治疗临床局限性前列腺癌患者，但在局部进展性疾病中的应用报道较少。我们评估了根治性前列腺切除术和即刻辅助雄激素剥夺治疗在日本 pT3N0M0 前列腺癌患者中的长期疗效。
方法
我们回顾性分析了 2000 年至 2006 年在我院接受根治性前列腺切除术的 128 例 pT3N0M0 前列腺癌患者。所有 pT3N0 患者在根治性前列腺切除术后均接受辅助雄激素剥夺治疗。即刻辅助雄激素剥夺治疗至少持续 5 年。由于术前激素治疗、数据缺失或其他原因，23 例患者被排除在外。通过 Kaplan-Meier 图分析任何原因导致的死亡、前列腺癌导致的死亡、临床复发和激素难治性生化进展。使用 Cox 比例风险模型估计进展的相对风险，并采用 95%置信区间。
结果
中位随访 8.2 年（范围 25.6-155.6 个月）后，10 年无激素难治性生化进展生存率为 88.3%，癌症特异性生存率为 96.3%。单因素分析显示，较高的临床分期（p=0.013）、较高的前列腺活检 Gleason 评分（p=0.001）、精囊侵犯（p=0.003）和微淋巴管侵犯（p=0.006）是激素难治性生化进展的预测因素。多因素分析显示，前列腺活检 Gleason 评分（p=0.027）和精囊侵犯（p=0.030）是激素难治性生化进展的独立预后因素。20 例临床 T1 癌症患者、12 例切缘阴性和 11 例神经周围侵犯阴性的患者均未发生激素难治性生化进展。
结论
根治性前列腺切除术联合即刻辅助雄激素剥夺治疗可能是治疗 pT3N0M0 前列腺癌患者的有效方法。
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