半侧前列腺低温冷冻消融治疗局限性低、中、高危前列腺癌：5 年肿瘤学和功能结局。
Hemigland Cryoablation of Localized Low, Intermediate and High Risk Prostate Cancer: Oncologic and Functional Outcomes at 5 Years.
机构信息
USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California.
Departments of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
出版信息
J Urol. 2019 Dec;202(6):1188-1198. doi: 10.1097/JU.0000000000000456. Epub 2019 Jul 26.
PURPOSE
We evaluated 5-year oncologic and functional outcomes of hemigland cryoablation of localized prostate cancer.
MATERIALS AND METHODS
We reviewed the records of 160 consecutive men who underwent hemigland cryoablation of localized prostate cancer. Recurrent and/or residual clinically significant prostate cancer was defined as Grade Group 2 or greater on followup biopsy. A prostate specific antigen nadir plus 2 ng/ml according to the Phoenix criteria was used to define biochemical failure. Radical treatment was defined as any whole gland therapy. Treatment failure was defined as any radical and/or whole gland treatment, systemic therapy initiation, metastasis or prostate cancer specific mortality. The study primary end point was treatment failure-free survival. The secondary end points were survival free of biochemical failure, clinically significant prostate cancer and radical treatment. Followup biopsy and functional outcomes were also evaluated. Statistical analysis included the Kaplan-Meier method, and univariate and multivariable Cox and logistic regression with significance considered at p <0.05.
RESULTS
Median patient age was 67 years, baseline prostate specific antigen was 6.3 ng/ml and followup was 40 months. A total of 131 patients (82%) had D'Amico intermediate (66%) or high risk (16%) prostate cancer. At 5 years the treatment failure-free survival rate was 85%, the biochemical failure-free survival rate was 62% and the survival rate free of clinically significant prostate cancer was 89%. Higher baseline prostate specific antigen independently predicted treatment failure (p <0.001), biochemical failure (p=0.048), recurrence and radical treatment (p <0.01). Grade Group 3 or greater independently predicted treatment failure (p=0.04). The metastasis-free survival rate was 100% at 5 years. Pad-free continence and potency (erections sufficient for intercourse) were retained in 97% and 73% of patients, respectively. There was no rectal fistula or mortality.
CONCLUSIONS
Hemigland cryoablation of localized prostate cancer provides effective midterm oncologic outcomes with good continence and potency. Patients with higher baseline prostate specific antigen are at increased risk for biochemical failure, recurrent cancer and treatment failure.
目的
我们评估了局限性前列腺癌半腺体冷冻消融的 5 年肿瘤学和功能结果。
材料和方法
我们回顾了 160 例连续接受局限性前列腺癌半腺体冷冻消融的男性患者的记录。复发性和/或残留的临床显著前列腺癌定义为随访活检中分级组 2 或更高。根据 Phoenix 标准，前列腺特异性抗原的最低值加 2ng/ml 用于定义生化失败。根治性治疗定义为任何全腺体治疗。治疗失败定义为任何根治性和/或全腺体治疗、全身治疗开始、转移或前列腺癌特异性死亡。研究的主要终点是治疗失败无生存。次要终点是无生化失败、无临床显著前列腺癌和无根治性治疗的生存。还评估了随访活检和功能结果。统计分析包括 Kaplan-Meier 方法以及单变量和多变量 Cox 和逻辑回归，显著性水平设为 p<0.05。
结果
中位患者年龄为 67 岁，基线前列腺特异性抗原为 6.3ng/ml，随访时间为 40 个月。共有 131 例患者（82%）患有 D'Amico 中危（66%）或高危（16%）前列腺癌。5 年时，治疗失败无生存的比例为 85%，生化失败无生存的比例为 62%，无临床显著前列腺癌生存的比例为 89%。较高的基线前列腺特异性抗原独立预测治疗失败（p<0.001）、生化失败（p=0.048）、复发和根治性治疗（p<0.01）。3 级或更高级别的分级独立预测治疗失败（p=0.04）。5 年时无转移生存的比例为 100%。97%的患者保留无尿垫控尿功能，73%的患者保留勃起功能（足以进行性交）。无直肠瘘或死亡。
结论
局限性前列腺癌半腺体冷冻消融可提供有效的中期肿瘤学结果，同时保持良好的控尿和勃起功能。基线前列腺特异性抗原较高的患者发生生化失败、复发性癌症和治疗失败的风险增加。
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