Moschini M, Morlacco A, Kwon E, Rangel L J, Karnes R J
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
Prostate Cancer Prostatic Dis. 2017 Mar;20(1):117-121. doi: 10.1038/pcan.2016.63. Epub 2017 Jan 3.
The aim of the study was to evaluate survival and perioperative outcomes of metastatic prostate cancer (mPCa) patients treated with surgery or androgen deprivation treatment (ADT) only.
We retrospectively selected 47 metastatic PCa patients treated at a single center (Mayo Clinic, Rochester, MN) by two urologists (RJK and EK) between 2007 and 2014. Overall, 31 (66%) underwent radical prostatectomy (RP) with or without adjuvant therapies and 16 (34%) underwent ADT only. Surgical patients were treated by a single surgeon (RJK). Complications and functional outcomes were recorded for surgery group. Cancer-specific mortality (CSM) was analyzed by Kaplan-Meier estimation. Univariable Cox regression analyses were used to test the risk factors associated with CSM in mPCa patients treated with RP.
Median age at diagnosis was 61 years. During median follow-up 38.8 months, 12 deaths were recorded. At 5 years, the overall CSM-free survival rate of the whole cohort was 57.9%. When patients were stratified according to the treatment, CSM-free survival rate at 5 years was 62% and 46% for patients who underwent surgery and ADT, respectively (P=0.3). Median length of stay was 3 days, with a 30 days readmission rate of 9.7%. The 30-day all complication rate was 29% (n=9). Specifically, we recorded: 2 lymphoceles (6.5%), 2 wound infection (6.5%), 2 ileus (6.5%), 2 hematoma (6.5%) and 1 anastomosis leak (3.2%). Within 90 days after surgery, 2 (6.5%) and 5 (16.1%) patients needed 1-2 supportive and 3 or more pads, respectively. However, continence was achieved by all treated patients during the follow-up period.
We demonstrated the feasibility of local surgical treatment of primary tumor in mPCa patients. However, in the short term, no survival benefits have been observed for patients treated with surgery when compared with patients treated with ADT only. Further prospective studies are warranted to explore the treatment of M1a/M1b prostate cancer patients.
本研究旨在评估仅接受手术或雄激素剥夺治疗（ADT）的转移性前列腺癌（mPCa）患者的生存率和围手术期结局。
我们回顾性选取了2007年至2014年间在单一中心（明尼苏达州罗切斯特市梅奥诊所）由两位泌尿科医生（RJK和EK）治疗的47例转移性PCa患者。总体而言，31例（66%）接受了根治性前列腺切除术（RP），伴或不伴辅助治疗，16例（34%）仅接受了ADT。手术患者由同一位外科医生（RJK）治疗。记录手术组的并发症和功能结局。采用Kaplan-Meier估计法分析癌症特异性死亡率（CSM）。单变量Cox回归分析用于检验接受RP治疗的mPCa患者中与CSM相关的危险因素。
诊断时的中位年龄为61岁。在中位随访38.8个月期间，记录到12例死亡。5年时，整个队列的总体无CSM生存率为57.9%。当根据治疗方式对患者进行分层时，接受手术和ADT治疗的患者5年无CSM生存率分别为62%和46%（P = 0.3）。中位住院时间为3天，30天再入院率为9.7%。30天全并发症发生率为29%（n = 9）。具体而言，我们记录到：2例淋巴囊肿（6.5%）、2例伤口感染（6.5%）、2例肠梗阻（6.5%）、2例血肿（6.5%）和1例吻合口漏（3.2%）。术后90天内，分别有2例（6.5%）和5例（16.1%）患者需要1 - 2片和3片或更多的护垫。然而，所有接受治疗的患者在随访期间均实现了控尿。
我们证明了mPCa患者原发性肿瘤局部手术治疗的可行性。然而，短期内，与仅接受ADT治疗的患者相比，接受手术治疗的患者未观察到生存获益。有必要进行进一步的前瞻性研究以探索M1a/M1b前列腺癌患者的治疗方法。
