Garzotto M, Wajsman Z
Department of Surgery, University of Florida, Gainesville, USA.
J Urol. 1998 Mar;159(3):950-4; discussion 954-5.
We studied the effect of the combination of androgen deprivation with salvage surgery in patients with radiorecurrent prostate cancer.
Salvage cystoprostatectomy or radical prostatectomy was performed in 29 patients with radiorecurrent prostate cancer. Of the 29 patients 24 had been treated with neoadjuvant hormonal therapy before salvage surgery, while in 5 an initial trial of androgen deprivation had failed preoperatively.
The positive surgical margin rate for all patients was 31%. Margin involvement correlated strongly with disease specific and disease-free survival. At a mean followup of 5.3 years disease specific survival was 95% in men with negative surgical margins compared with 44% in those with positive surgical margins (p = 0.002). Similarly, clinical and biochemical disease-free survival was 80% in patients with negative surgical margins, while only 44% of those with positive surgical margins remained disease-free (p = 0.05). Surgical margins were positive in 80% of the men in the androgen deprivation failure group and in 21% in the neoadjuvant hormonal therapy group (p = 0.001). The disease specific survival rate after an initial trial of androgen deprivation failed was only 20% compared with 92% after neoadjuvant hormonal therapy was given preoperatively (p = 0.001)
The combination of neoadjuvant hormonal therapy with salvage surgery for radiorecurrent prostate cancer resulted in a low incidence of surgical margin involvement, which correlated strongly with disease specific and disease-free survival. Patients with radiorecurrent prostate cancer in whom an initial trial of androgen deprivation fails appear to be poor candidates for salvage prostatectomy.
我们研究了雄激素剥夺联合挽救性手术对放射性复发前列腺癌患者的影响。
对29例放射性复发前列腺癌患者实施了挽救性膀胱前列腺切除术或根治性前列腺切除术。29例患者中，24例在挽救性手术前接受了新辅助激素治疗，而5例患者术前雄激素剥夺初始试验失败。
所有患者的手术切缘阳性率为31%。切缘受累与疾病特异性生存率和无病生存率密切相关。平均随访5.3年，手术切缘阴性的男性患者疾病特异性生存率为95%，而切缘阳性的患者为44%（p = 0.002）。同样，手术切缘阴性患者的临床和生化无病生存率为80%，而切缘阳性患者中只有44%无病生存（p = 0.05）。雄激素剥夺失败组80%的男性患者手术切缘阳性，新辅助激素治疗组为21%（p = 0.001）。初始雄激素剥夺试验失败后的疾病特异性生存率仅为20%，而术前给予新辅助激素治疗后的生存率为92%（p = 0.001）。
新辅助激素治疗联合挽救性手术治疗放射性复发前列腺癌可降低手术切缘受累的发生率，且与疾病特异性生存率和无病生存率密切相关。初始雄激素剥夺试验失败的放射性复发前列腺癌患者似乎不是挽救性前列腺切除术的合适人选。
