挽救性冷冻消融治疗放射性复发性前列腺癌的长期肿瘤学结局。

Long-Term Oncologic Outcomes of Salvage Cryoablation for Radio-Recurrent Prostate Cancer.

机构信息

Western University, London, Ontario, Canada.

University of Dammam, Dammam, Saudi Arabia.

出版信息

J Urol. 2016 Oct;196(4):1105-11. doi: 10.1016/j.juro.2016.04.080. Epub 2016 May 6.

DOI:10.1016/j.juro.2016.04.080

PMID:27157372

Abstract

PURPOSE

Management of localized radio-recurrent prostate cancer is not standardized, partly due to the absence of long-term data on oncologic control and the toxicity of various treatment modalities. We analyzed the long-term oncologic outcomes and morbidity of salvage cryoablation for radio-recurrent prostate cancer.

MATERIALS AND METHODS

Patients undergoing salvage cryoablation for biopsy proven, localized radio-recurrent prostate cancer from 1995 to 2004 were prospectively accrued. Preoperative characteristics, perioperative morbidity and postoperative data were reviewed from a prospectively maintained database or via telephonic contact with the patient. The primary outcome was overall survival. Secondary outcomes were metastasis-free and biochemical disease-free survival. The Kaplan-Meier method was used for survival analysis and multivariable Cox regression analysis was performed.

RESULTS

Of 187 patients 157 (84%) had records available for followup. Mean ± SD age was 69.4 ± 5.8 years and mean presalvage prostate specific antigen was 6.6 ± 5.7 ng/ml. Median followup was 117 months (IQR 55-154). Five and 10-year overall survival was 93% and 76%, respectively. Biochemical disease-free survival at 10 and 15 years was 35% and 22.6% whereas metastasis-free survival at 10 and 15 years was 86% and 71%, respectively. On multivariable analysis precryoablation and nadir prostate specific antigen values were significant predictors of metastasis-free and biochemical disease-free survival. Age at salvage cryoablation (p = 0.008) and nadir prostate specific antigen (p = 0.015) were significant predictors of overall survival. There were 157 Clavien-Dindo grade 1-2 and 22 grade 3 complications.

CONCLUSIONS

A single center, long-term experience documented by a prospectively maintained database shows that cryoablation is a viable salvage option for radio-recurrent prostate cancer as it provides durable biochemical disease-free survival with acceptable morbidity.

摘要

目的

局部放射性复发性前列腺癌的治疗方法尚未标准化，部分原因是缺乏长期的肿瘤控制和各种治疗方式毒性的相关数据。我们分析了挽救性冷冻消融治疗放射性复发性前列腺癌的长期肿瘤学结果和发病率。

材料与方法

1995 年至 2004 年间，前瞻性地收集了经活检证实的局部放射性复发性前列腺癌患者，行挽救性冷冻消融治疗。从前瞻性维护的数据库或通过与患者电话联系，回顾术前特征、围手术期发病率和术后数据。主要结果是总生存率。次要结果是无转移和生化无复发生存率。采用 Kaplan-Meier 方法进行生存分析，并进行多变量 Cox 回归分析。

结果

187 例患者中，157 例（84%）有随访记录。平均年龄为 69.4 ± 5.8 岁，平均 PSA 为 6.6 ± 5.7ng/ml。中位随访时间为 117 个月（IQR 55-154）。5 年和 10 年总生存率分别为 93%和 76%。10 年和 15 年的生化无复发生存率分别为 35%和 22.6%，而无转移生存率分别为 86%和 71%。多变量分析显示，冷冻消融前和 PSA 最低值是无转移和生化无复发生存率的显著预测因素。挽救性冷冻消融时的年龄（p = 0.008）和 PSA 最低值（p = 0.015）是总生存率的显著预测因素。发生 157 例 Clavien-Dindo 1-2 级和 22 例 3 级并发症。