Cheng C W, Bergstralh E J, Zincke H
Department of Urology, Mayo Clinic, Rochester, MN 55905.
Cancer. 1993 Feb 1;71(3 Suppl):996-1004. doi: 10.1002/1097-0142(19930201)71:3+<996::aid-cncr2820711417>3.0.co;2-8.
Untreated Stage D1 prostate cancer is associated with a high progression rate. Various treatment modalities involving monotherapy alone have been associated with dismal results. In this retrospective study, the impact of combination therapy, local (surgery or radiation) and systemic (hormonal), compared with that of monotherapy on disease outcome was evaluated.
The authors reviewed 631 patients who underwent pelvic lymphadenectomy for Stage D1 prostate cancer: 251 had radical prostatectomies and orchiectomies, 78 had radical prostatectomies alone, 97 received local irradiation and underwent orchiectomies, and 60 had orchiectomies alone.
Cause-specific survival rates for prostatectomy-orchiectomy-treated (PO) patients at 5 and 10 years were 91% and 78%, respectively; they were 84% and 54% for irradiation-orchiectomy-treated (IO) patients and 66% and 39% for orchiectomy alone-treated (O) patients, respectively. Controlling for the number of nodes, the difference between PO-treated and IO-treated patients was not significant; the former group had a significantly longer survival than the O-treated patients (P = 0.037). The 5-year and 10-year cause-specific survival rates for prostatectomy alone-treated patients were 91% and 75%, respectively, and 84% and 45% for irradiation alone-treated patients. Thus, cause-specific survival rates in prostatectomy alone-treated patients were significantly better (P = 0.0085).
For patients with Stage D1 prostate adenocarcinoma, radical prostatectomy and local irradiation as local treatments when combined with orchiectomy produce similar outcomes. These results should be verified in a prospective study.
未经治疗的D1期前列腺癌具有较高的进展率。各种仅涉及单一疗法的治疗方式效果均不佳。在这项回顾性研究中，评估了局部（手术或放疗）与全身（激素）联合治疗与单一疗法相比对疾病转归的影响。
作者回顾了631例行盆腔淋巴结清扫术的D1期前列腺癌患者：251例行根治性前列腺切除术和睾丸切除术，78例仅行根治性前列腺切除术，97例接受局部放疗并同时行睾丸切除术，60例仅行睾丸切除术。
接受前列腺切除术-睾丸切除术（PO）治疗的患者5年和10年的病因特异性生存率分别为91%和78%；接受放疗-睾丸切除术（IO）治疗的患者分别为84%和54%，仅接受睾丸切除术（O）治疗的患者分别为66%和39%。在控制淋巴结数量后，PO治疗组和IO治疗组患者之间的差异不显著；前一组的生存期明显长于O治疗组患者（P = 0.037）。仅接受前列腺切除术治疗的患者5年和10年的病因特异性生存率分别为91%和75%，仅接受放疗治疗的患者分别为84%和45%。因此，仅接受前列腺切除术治疗的患者的病因特异性生存率明显更好（P = 0.0085）。
对于D1期前列腺腺癌患者，根治性前列腺切除术和局部放疗作为局部治疗与睾丸切除术联合应用时产生相似的结果。这些结果应在前瞻性研究中得到验证。
