Frohmüller H G, Theiss M, Manseck A, Wirth M P
Department of Urology, University of Würzburg Medical School, Germany.
Eur Urol. 1995;27(3):202-6. doi: 10.1159/000475161.
A series of 139 patients with histologically proven stage D1 (T1-3 pN1-2 M0) prostate cancer was reviewed in order to determine the influence of radical surgery in addition to hormonal treatment on long-term outcome with respect to survival and quality of life. In all 139 patients a pelvic lymphadenectomy was performed. In 87 patients, lymphadenectomy was followed by androgen deprivation alone (group 1). Fifty-two patients underwent additional radical prostatectomy (group 2). The actuarial 10-year nonprogression rates were 14.6% in group 1 and 35.8% in group 2, respectively (p = 0.0016). The overall and disease-specific 10-year survival rates were found to be 29.7 and 32.1%, respectively, for group 1 and 50.8 and 70.7%, respectively, for group 2. Local progression as the main parameter influencing quality of life occurred in 60 of the 87 patients (69%) not subjected to radical prostatectomy. Transurethral resection of the prostate was required in 29 of these patients. In contrast, following radical prostatectomy, only 4 of the 52 patients (8%) had local progression and only 1 patient (2%) needed a dilatation of the vesicourethral anastomosis for relief of infravesical obstruction. Thus, radical prostatectomy plus androgen deprivation for patients with stage D1 prostate cancer appeared to be superior to androgen deprivation alone with respect to survival expectancy and quality of life. Prospective randomized trials, however, have to be undertaken to verify these results.
回顾了139例经组织学证实为D1期（T1-3 pN1-2 M0）前列腺癌的患者，以确定除激素治疗外，根治性手术对生存和生活质量的长期预后的影响。所有139例患者均接受了盆腔淋巴结清扫术。87例患者仅在淋巴结清扫术后接受雄激素剥夺治疗（第1组）。52例患者额外接受了根治性前列腺切除术（第2组）。第1组和第2组的精算10年无进展率分别为14.6%和35.8%（p = 0.0016）。第1组的10年总生存率和疾病特异性生存率分别为29.7%和32.1%，第2组分别为50.8%和70.7%。在87例未接受根治性前列腺切除术的患者中，有60例（69%）出现了作为影响生活质量主要参数的局部进展。其中29例患者需要行经尿道前列腺切除术。相比之下，在接受根治性前列腺切除术后，52例患者中只有4例（8%）出现局部进展，只有1例患者（2%）需要扩张膀胱尿道吻合处以缓解膀胱下梗阻。因此，对于D1期前列腺癌患者，根治性前列腺切除术联合雄激素剥夺治疗在预期生存率和生活质量方面似乎优于单纯雄激素剥夺治疗。然而，必须进行前瞻性随机试验来验证这些结果。
