Carter G E, Lieskovsky G, Skinner D G, Petrovich Z
Department of Urology, University of Southern California School of Medicine, Los Angeles.
J Urol. 1989 Nov;142(5):1266-70; discussion 1270-1. doi: 10.1016/s0022-5347(17)39052-3.
Between 1976 and 1984, 47 of 108 patients (44%) who underwent radical retropubic prostatectomy and pelvic lymphadenectomy for clinical stage A2 or B adenocarcinoma of the prostate were found to have pathological stage C or D1 disease. A total of 31 consecutive patients with pathological stage C disease received 45 to 55 Gy. adjuvant external beam radiation postoperatively. Actuarial 5 and 10-year survival rates free of disease were 92%, with a local recurrence rate of 3% and a distant recurrence rate of 6% at a mean followup of 5 years. Sixteen consecutive pathological stage D1 cancer patients received 45 to 60 Gy. adjuvant external beam radiation alone (4), adjuvant cytotoxic chemotherapy alone with cyclophosphamide (5) or combined adjuvant radiation and chemotherapy (7). Actuarial 5 and 10-year survival rates free of disease were 86% with no local recurrences and a distant recurrence rate of 12% at a mean followup of 5 years. These results provide further evidence to support the use of adjuvant external beam radiation therapy in the management of pathological stage C disease. Our preliminary results suggest that an aggressive, multidisciplinary approach is warranted in pathological stage D1 disease and that adjuvant chemotherapy, with or without adjuvant radiation, may have a role in prolonging survival free of disease in this high risk group.
1976年至1984年间，108例因临床分期为A2或B期前列腺腺癌而接受耻骨后前列腺根治术及盆腔淋巴结清扫术的患者中，47例（44%）被发现患有病理分期为C期或D1期疾病。共有31例连续的病理分期为C期的患者术后接受了45至55 Gy的辅助外照射放疗。精算得出的5年和10年无病生存率为92%，平均随访5年时局部复发率为3%，远处复发率为6%。16例连续的病理分期为D1期的癌症患者单独接受了45至60 Gy的辅助外照射放疗（4例）、单独接受环磷酰胺辅助细胞毒性化疗（5例）或辅助放疗与化疗联合治疗（7例）。精算得出的5年和10年无病生存率为86%，无局部复发，平均随访5年时远处复发率为12%。这些结果为支持在病理分期为C期疾病的治疗中使用辅助外照射放疗提供了进一步证据。我们的初步结果表明，对于病理分期为D1期的疾病，采用积极的多学科方法是必要的，并且辅助化疗，无论是否联合辅助放疗，可能在延长这一高危组的无病生存期方面发挥作用。
