Seay T M, Blute M L, Zincke H
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Urol. 1998 Feb;159(2):357-64. doi: 10.1016/s0022-5347(01)63917-x.
We assessed retrospectively the outcome after bilateral pelvic lymphadenectomy and radical prostatectomy for pathological pTxN+ adenocarcinoma of the prostate when treated with or without adjuvant androgen ablation therapy.
A total of 790 men treated with radical prostatectomy for prostatic adenocarcinoma were found to have pTxN+ disease and treated further with or without androgen ablation therapy. Mean patient age was 64 years (range 40 to 79). Mean followup was 6.5 years, (range up to 25). Clinical stages were T2 or less in 60% of the cases, T3 in 38% and N+ in 2%. Gleason scores were 6 or less in 31% and 7 or greater in 69%. Deoxyribonucleic acid ploidy was diploid in 43%, tetraploid in 39% and aneuploid in 18%. Of the patients 96 (12%) received no androgen ablation therapy, with the remainder getting androgen ablation therapy within 90 days of radical prostatectomy.
Of the patients 186 (24%) died, with 109 (14%) dying of prostatic anedocarcinoma. Overall (and cause specific) survival probabilities at 5, 10 and 15 years were 87 (91), 69 (79) and 39% (60%), respectively. Patients with diploid tumors had better cause specific survival than those with nondiploid tumors (p = 0.009). Patients with diploid tumors were less likely to have progression biochemically, locally or systemically than those with nondiploid tumors (p = 0.038). Androgen ablation therapy had no effect on cause specific survival in nondiploid patients. Diploid patients treated with androgen ablation therapy for up to 10 years had no improvement in disease specific survival compared to those with no androgen ablation therapy. However, cancer death was significantly reduced after 10 years (p <0.002). The local control rate of pTxN+ cases that receive radical prostatectomy and androgen ablation therapy at 15 years is virtually identical to that of stage pT2c cases at our institution (79 +/- 3.0 versus 80% +/- 3.5%, respectively). There were no deaths secondary to radical prostatectomy, and complications were within the experience of that seen in patients with localized disease.
Radical prostatectomy with androgen ablation therapy is a viable option for patients with pTxN+ disease, particularly in view of excellent local control rates and low morbidity. Patients with diploid tumors have a more favorable outcome than those with nondiploid tumors when treated with androgen ablation therapy.
我们回顾性评估了双侧盆腔淋巴结清扫术及根治性前列腺切除术后，病理分期为pTxN +的前列腺腺癌患者接受或未接受辅助雄激素剥夺治疗的预后情况。
共有790例接受前列腺腺癌根治性前列腺切除术的男性被发现患有pTxN +疾病，并接受了或未接受雄激素剥夺治疗。患者平均年龄为64岁（范围40至79岁）。平均随访时间为6.5年（范围长达25年）。60%的病例临床分期为T2或更低，38%为T3，2%为N +。Gleason评分6分或更低的占31%，7分或更高的占69%。43%的患者脱氧核糖核酸倍体为二倍体，39%为四倍体，18%为非整倍体。96例（12%）患者未接受雄激素剥夺治疗，其余患者在根治性前列腺切除术后90天内接受了雄激素剥夺治疗。
186例（24%）患者死亡，其中109例（14%）死于前列腺癌。5年、10年和15年的总体（及病因特异性）生存率分别为87%（91%）、69%（79%）和39%（60%）。二倍体肿瘤患者的病因特异性生存率高于非二倍体肿瘤患者（p = 0.009）。二倍体肿瘤患者在生化、局部或全身进展方面的可能性低于非二倍体肿瘤患者（p = 0.038）。雄激素剥夺治疗对非二倍体患者的病因特异性生存率没有影响。接受雄激素剥夺治疗长达10年的二倍体患者与未接受雄激素剥夺治疗的患者相比，疾病特异性生存率没有改善。然而，10年后癌症死亡显著减少（p <0.002）。接受根治性前列腺切除术和雄激素剥夺治疗的pTxN +病例15年的局部控制率与我院pT2c期病例的局部控制率几乎相同（分别为79%±3.0%和80%±3.5%）。根治性前列腺切除术没有导致死亡，并发症在局限性疾病患者的经验范围内。
对于pTxN +疾病患者，根治性前列腺切除术联合雄激素剥夺治疗是一种可行的选择，特别是考虑到其出色的局部控制率和低发病率。在接受雄激素剥夺治疗时，二倍体肿瘤患者的预后比非二倍体肿瘤患者更有利。
