腹腔镜根治性前列腺切除术联合扩大淋巴结清扫术并立即进行雄激素剥夺治疗用于pT3-4N0-1M0前列腺癌病例：一项8年随访的多模式研究
Laparoscopic Radical Prostatectomy Plus Extended Lymph Node Dissection in Combination With Immediate Androgen Deprivation Therapy for Cases of pT3-4N0-1M0 Prostate Cancer: A Multimodal Study of 8 Years' Follow-up.
作者信息
Yang Yi, Luo Yun, Hou Guo-Liang, Huang Qun-Xiong, Pang Jun, Gao Xin
机构信息
Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Urology, Foshan First Municipal People's Hospital, Foshan, China.
出版信息
Clin Genitourin Cancer. 2016 Aug;14(4):e321-7. doi: 10.1016/j.clgc.2015.11.009. Epub 2015 Nov 18.
PURPOSE
To investigate the functional and oncologic outcomes of patients with locally advanced or lymph node (LN) metastatic prostate cancer (PCa) treated by laparoscopic radical prostatectomy (LRP) with extended lymph node dissection (ePLND).
METHODS
From June 2004 to March 2014, a total of 232 cases (pT3-4N0-1M0) including 160 locally advanced PCa and 72 LN metastatic PCa who received immediate androgen deprivation therapy after LRP plus ePLND were enrolled onto our study. The patients were followed up for 12 to 124 months. Surgical records, surgical margin status, complications, urinary continence, and oncologic outcomes were presented.
RESULTS
The mean operation time and bleeding were 230 minutes and 105 mL, respectively. The rates of urinary continence were 91.4% and 94.8% at 6 and 12 months, respectively. We observed 122 biochemical recurrent cases. The 5- and 8-year biochemical relapse-free survival rates were 47.3% and 46.7%, respectively. The 5- and 8-year overall and cancer-specific survivals were 81.2%, 80.1%, 90.6%, and 90.6%, respectively. The survival analysis showed that biochemical recurrence-free survival rates were significantly lower for patients with higher Gleason score (77.3% vs. 39.6% vs. 30.8%, P = .003 log rank), higher T stage (55.7% vs. 41.4% vs. 21.4%, P = .039 log rank), positive surgical margin (51.1% vs. 29.3%, P = .000 log rank), and higher CAPRA-S score (68.6% vs. 35.0% vs. 29.2%, P = .000 log rank). There were no significant differences in biochemical relapse-free (40.9% vs. 49.3%, P = .286), overall (75.6% vs. 81.9%, P = .398), and cancer-specific (87.3% vs. 92.1%, P = .284) survival between LN-positive and -negative PCa.
CONCLUSION
LRP plus ePLND in combination with immediate androgen deprivation therapy is a feasible approach to patients with pT3-4N0-1M0 PCa; favorable functional and oncologic outcomes were presented postoperatively.
目的
探讨接受腹腔镜根治性前列腺切除术（LRP）联合扩大淋巴结清扫术（ePLND）治疗的局部晚期或淋巴结（LN）转移前列腺癌（PCa）患者的功能和肿瘤学结局。
方法
2004年6月至2014年3月，共有232例（pT3 - 4N0 - 1M0）患者入组本研究，其中包括160例局部晚期PCa和72例LN转移PCa，这些患者在LRP联合ePLND术后接受了即刻雄激素剥夺治疗。对患者进行了12至124个月的随访。呈现了手术记录、手术切缘状态、并发症、尿失禁情况和肿瘤学结局。
结果
平均手术时间和出血量分别为230分钟和105毫升。6个月和12个月时的尿失禁率分别为91.4%和94.8%。我们观察到122例生化复发病例。5年和8年的生化无复发生存率分别为47.3%和46.7%。5年和8年的总生存率及癌症特异性生存率分别为81.2%、80.1%、90.6%和90.6%。生存分析显示，Gleason评分较高（77.3%对39.6%对30.8%，P = 0.003对数秩检验）、T分期较高（55.7%对41.4%对21.4%，P = 0.039对数秩检验）、手术切缘阳性（51.1%对29.3%，P = 0.000对数秩检验）以及CAPRA - S评分较高（68.6%对35.0%对29.2%，P = 0.000对数秩检验）的患者生化无复发生存率显著较低。LN阳性和阴性PCa患者在生化无复发生存率（40.9%对49.3%，P = 0.286）、总生存率（75.6%对81.9%，P = 0.398）和癌症特异性生存率（87.3%对92.1%，P = 0.284）方面无显著差异。
结论
LRP联合ePLND并即刻给予雄激素剥夺治疗是pT3 - 4N0 - 1M0 PCa患者的一种可行方法；术后呈现了良好的功能和肿瘤学结局。
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