摘要
目的探讨新辅助内分泌治疗联合化疗(NCHT)对极高危局部进展期前列腺癌的临床疗效。方法回顾性分析上海交通大学医学院附属仁济医院、天津医科大学第二医院、中山大学附属第三医院2014年12月至2019年7月共327例极高危局部进展期前列腺癌患者的临床资料。根据治疗方式分组,直接行RP者为RP组,NCHT后行RP者为NCHT组。RP组171例,中位年龄67(44~83)岁,中位初诊前列腺特异性抗原(PSA)27.24(4.55~207.00)ng/ml;临床分期cT2期13例,cT_(3a)期85例,cT_(3b)期57例,cT_(4)期16例;cN_(0)期138例,cN_(1)分期33例;穿刺病理国际泌尿病理协会(ISUP)分级分组1组5例,2组35例,3组41例,4组51例,5组39例。NCHT组156例,中位年龄67(46~78)岁,中位初诊PSA 72.09(4.08~722.95)ng/ml;临床分期cT_(2)期11例,cT_(3a)期47例,cT_(3b)期58例,cT_(4)期40例;cN0期80例,cN_(1)期76例;穿刺病理ISUP分级分组1组1例,2组11例,3组33例,4组43例,5组68例。NCHT组较RP组有更高的PSA、更高的ISUP分级分组和更晚期的TNM分期。RP组行RP+盆腔扩大淋巴结清扫术;NCHT组行RP(手术方式同RP组)术前,先接受戈舍瑞林/亮丙瑞林皮下注射(每28天1次)+多西他赛75mg/m^(2)静脉滴注(每3周1次),共4~6个周期。比较两组患者术后PSA水平、病理分期变化、切缘阳性率,以及无生化复发生存期的差异。结果NCHT组较RP组术后达根治水平(术后6周PSA<0.2 ng/ml)的比例[80.1%(125/156)与48.5%(83/171)]、T分期降期比例[60.9%(95/156)与14.6%(25/171)]、ISUP分级分组降组比例[49.4%(77/156)与11.7%(20/171)]更高(均P<0.001),术后病理切缘阳性的比例更低[17.9%(28/156)与44.4%(76/171)],且NCHT组17例(10.9%)术后病理提示pT0或微小残留病变。NCHT组较RP组中位无生化复发生存期显著延长(19.46个月与6.35个月,P<0.001)。多因素Cox回归分析结果显示,NCHT可显著降低患者生化复发风险(HR=0.278,95%CI 0.198~0.390,P<0.001)。在亚组分析中,NCHT组较RP组在年龄>65岁(HR=0.225)�
Objective To investigate the clinical efficacy of neoadjuvant chemo-hormonal therapy(NCHT)followed by radical prostatectomy(RP)plus extended pelvic lymphadenectomy for very-high-risk locally advanced prostate cancer.Methods The data of 327 cases of very-high-risk locally advanced prostate cancer treated in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine,The Second Hospital of Tianjin Medical University,and The Third Affiliated Hospital of Sun Yat-sen University from December 2014 to July 2019 were retrospectively analyzed.Patients were divided into two groups according to treatment regimens:the RP group(direct RP+extended pelvic lymphadenectomy 4-6 weeks after the biopsy of prostate)and the NCHT group(4-6 cycles of NCHT prior to RP).There were 171 cases in RP group and 156 cases in NCHT group,respectively.In the RP group,the median age was 67(ranging 44-83)years.The median PSA at diagnosis was 27.24(ranging 4.55-207.00)ng/ml.Patients’numbers of clinical T2,T_(3a),T_(3)b,T_(4)stage were 13,85,57,16,respectively,and clinical N_(1),N0 stage were 33 and 138,respectively.Patients’numbers of ISUP grade groups of 1,2,3,4,5 were 5,35,41,51,39,respectively.In the NCHT group,The median age was 67 years,ranging 46-78 years.The median PSA at diagnosis was 72.09(ranging 4.08-722.95)ng/ml.Patients’numbers of clinical T_(2),T_(3a),T_(3)b,T_(4)stage were 11,47,58,40,respectively,and clinical N_(1),N0stage were 76 and 80,respectively.Patients’numbers of ISUP grade groups of 1,2,3,4,5 were 1,11,33,43,68,respectively.At baseline,the NCHT group showed higher PSA,higher ISUP grade,and more advanced clinical stage at diagnosis(P<0.05).The PSA,pathological down-staging rate,and positive surgical margin rate as well as the biochemical recurrence free survival(bRFS)were compared between the two groups.Results After radical prostatectomy,compared with the RP group,the NCHT group had a higher proportion of patients achieving PSA<0.2 ng/ml at 6-week postoperative follow-up(P<0.001),a higher pathologic tu
作者
潘家骅
刘家舟
王勇
迟辰斐
朱寅杰
沙建军
董柏君
高新
牛远杰
薛蔚
Pan Jiahua;Liu Jiazhou;Wang Yong;Chi Chenfei;Zhu Yinjie;Sha Jianjun;Dong Baijun;Gao Xin;Niu Yuanjie;Xue Wei(Department of Urology,Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Department of Urology,The Second Hospital of Tianjin Medical University,Tianjin 300211,China;Department of Urology,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2021年第9期685-690,共6页
Chinese Journal of Urology
基金
国家自然科学基金(82072847)。
关键词
前列腺肿瘤
新辅助治疗
多西他赛
生化复发
Prostatic neoplasms
Neoadjuvant therapy
Docetaxel
Biochemical recurrence
