高强度聚焦超声治疗局限性前列腺癌的大样本聚焦或半切除治疗患者的中期肿瘤学结果。

Medium-term oncological outcomes in a large cohort of men treated with either focal or hemi-ablation using high-intensity focused ultrasonography for primary localized prostate cancer.

机构信息

Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.

Department of Urology and Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.

出版信息

BJU Int. 2019 Sep;124(3):431-440. doi: 10.1111/bju.14710. Epub 2019 Mar 18.

DOI:10.1111/bju.14710

PMID:30753756

Abstract

OBJECTIVE

To report medium-term oncological outcomes in men receiving primary focal treatment with high-intensity focused ultrasonography ( HIFU) for prostate cancer (PCa).

PATIENTS AND METHODS

Consecutive patients with PCa treated with primary focal HIFU at two centres by six treating clinicians were assessed. Patients were submitted to either focal ablation or hemi-ablation using HIFU (Sonablate 500). The primary objective of the study was to assess medium-term oncological outcomes, defined as overall survival, freedom from biopsy failure, freedom from any further treatment and freedom from radical treatment after focal HIFU. The secondary objective was to evaluate the changes in pathological features among patients treated with focal HIFU over time. We also assessed the relationship between year of surgery and 5-year retreatment probability.

RESULTS

A total of 1032 men treated between November 2005 and October 2017 were assessed. The median age was 65 years and median prostate-specific antigen level was 7 ng/mL. The majority of patients had a Gleason score of 3 + 4 or above (80.3%). The median (interquartile range) follow-up was 36 (14-64) months. The overall survival rates at 24, 60 and 96 months were 99%, 97% and 97%, respectively. Freedom from biopsy failure, defined as absence of Gleason 3 + 4 disease, was 84%, 64% and 54% at 24, 60 and 96 months. Freedom from any further treatment was 85%, 59% and 46% at 24, 60 and 96 months, respectively. Approximately 70% of patients who were retreated received a second focal treatment. Freedom from radical treatment was 98%, 91% and 81% at 24, 60 and 96 months. During the study period, we observed an increase in the proportion of patients undergoing focal HIFU with Gleason 3 + 4 disease and with T2 stage disease as defined by multiparametric magnetic resonance imaging. Finally, there was a reduction over time in the proportion of patients undergoing re-treatment within 5 years of first treatment.

CONCLUSIONS

Focal HIFU for PCa is a feasible therapeutic strategy, with acceptable survival and oncological results and a reduction in the 5-year retreatment rates over the last decade. Re-do focal treatment is a feasible technique whose functional and oncological outcomes have still to be evaluated.

摘要

目的

报告高强度聚焦超声（HIFU）治疗前列腺癌（PCa）的男性患者的中期肿瘤学结果。

方法

评估了两家中心的六位治疗医生对接受原发性局灶性 HIFU 治疗的连续 PCa 患者。患者接受了 HIFU（Sonablate 500）的局灶性消融或半消融。该研究的主要目的是评估中期肿瘤学结果，定义为总生存率、无活检失败、无任何进一步治疗和无局灶性 HIFU 后根治性治疗的自由。次要目的是评估随着时间的推移，接受局灶性 HIFU 治疗的患者的病理特征变化。我们还评估了手术年份与 5 年再治疗概率之间的关系。

结果

共评估了 1032 名 2005 年 11 月至 2017 年 10 月期间接受治疗的男性患者。中位年龄为 65 岁，中位前列腺特异性抗原水平为 7ng/ml。大多数患者的 Gleason 评分在 3+4 或以上（80.3%）。中位（四分位间距）随访时间为 36（14-64）个月。24、60 和 96 个月的总生存率分别为 99%、97%和 97%。24、60 和 96 个月时无活检失败的比例分别为 84%、64%和 54%，定义为无 Gleason 3+4 疾病。24、60 和 96 个月时无任何进一步治疗的比例分别为 85%、59%和 46%。约 70%的再治疗患者接受了第二次局灶治疗。24、60 和 96 个月时无根治性治疗的比例分别为 98%、91%和 81%。在研究期间，我们观察到接受局灶性 HIFU 治疗的患者中，Gleason 3+4 疾病和多参数磁共振成像定义的 T2 期疾病的比例增加。最后，在第一个治疗后的 5 年内，再治疗的比例随时间减少。