Pelletier Joanie, Cyr Sarah-Jeanne, Julien Anne-Sophie, Fradet Yves, Lacombe Louis, Toren Paul
Department of Surgery, Faculty of Medicine, Université Laval, Québec, Canada.
Clinical Research Platform, Research Centre of the CHU de Québec-Université Laval, Québec, Canada.
Urol Oncol. 2018 Aug;36(8):363.e7-363.e11. doi: 10.1016/j.urolonc.2018.05.004. Epub 2018 Jun 5.
Advanced prostate cancer may cause significant local complications which affect quality of life, including bladder outlet obstruction and hematuria. We performed a detailed review of our outcomes of palliative transurethral resection of the prostate (pTURP) in the era of taxane chemotherapy and potent androgen receptor antagonists at our tertiary-care institution.
Using hospital coding data, we identified patients with a diagnosis of prostate cancer who underwent a TURP at Hotel-Dieu Hospital in Quebec City between 2006 and 2016 for detailed chart review. Co-morbidities were classified using the Charlson comorbidity index (CCI). Cox regression analyses assessed predictors of perioperative mortality and morbidity.
Of 137 patients identified, 58 were included in our study. Median age was 68 years; 27 (47%) men had castration-resistant prostate cancer and 28 (48%) were metastatic at time of pTURP. Mean follow-up from the first pTURP was 2.2 years, with an estimated 5-year overall survival of 16.3% (95% CI: 6.5%-29.8%). Castration-resistant prostate cancer, CCI ≥5, and age predicted poorer survival. Primary indication for pTURP was bladder outlet obstruction (69%) or hematuria (22%). Postoperative Clavien 0, 1, 2, 3, 4, 5 complications occurred in 20 (34%), 16 (28%), 18 (31%), 3 (5%), 0, and 1 (2%) patients, respectively. Overall, 17 (27%) men underwent ≥1 redo pTURPs and 16 (28%) eventually had an indwelling catheter. Nephrostomy tubes or ureteral stents in place before pTURP remained indefinitely in all cases.
We conclude palliative TURP remains an important surgical option to relieve bladder outlet obstruction in patients with locally advanced prostate cancer, but is ineffective to relieve ureteral obstruction.
晚期前列腺癌可能导致严重的局部并发症，影响生活质量，包括膀胱出口梗阻和血尿。我们对在我们三级医疗机构的紫杉烷化疗和强效雄激素受体拮抗剂时代进行姑息性经尿道前列腺切除术（pTURP）的结果进行了详细回顾。
利用医院编码数据，我们确定了2006年至2016年期间在魁北克市迪厄医院接受TURP的前列腺癌患者，以进行详细的病历审查。使用Charlson合并症指数（CCI）对合并症进行分类。Cox回归分析评估围手术期死亡率和发病率的预测因素。
在确定的137例患者中，58例纳入我们的研究。中位年龄为68岁；27例（47%）男性患有去势抵抗性前列腺癌，28例（48%）在pTURP时已发生转移。首次pTURP后的平均随访时间为2.2年，估计5年总生存率为16.3%（95%CI：6.5%-29.8%）。去势抵抗性前列腺癌、CCI≥5和年龄是生存较差的预测因素。pTURP的主要指征是膀胱出口梗阻（69%）或血尿（22%）。术后Clavien 0、1、2、3、4、5级并发症分别发生在20例（34%）、16例（28%）、18例（31%）、3例（5%）、0例和1例（2%）患者中。总体而言，17例（27%）男性接受了≥1次再次pTURP，16例（28%）最终留置了导尿管。所有病例中，pTURP前放置的肾造瘘管或输尿管支架均长期保留。
我们得出结论，姑息性TURP仍然是缓解局部晚期前列腺癌患者膀胱出口梗阻的重要手术选择，但对缓解输尿管梗阻无效。
