前列腺偶发癌病理分级与患者生存期的观察

The Relationship between Pathological Grade of Incidental Prostate Carcinoma andPatient Survival

目的:分析良性前列腺增生(BPH)术后,前列腺偶发癌(IDPC)的特点,治疗方法和随访结果,探讨病理分级与治疗方法和患者生存期的关系。方法:回顾性分析1982～2006年因BPH行前列腺摘除术或经尿道前列腺电切术(TURP)1510例资料中发现IDPC68例,按Mostofi′s分级:Ⅰ级24例,Ⅱ级34例,Ⅲ级10例。睾丸切除术56例,睾丸切除加内分泌治疗48例,单纯内分泌治疗6例,观察等待6例。结果:65例随访1～10年,失访3例,因癌死亡9例,Mostofi′sⅢ级者5例,Ⅱ级者4例,平均生存期分别为20.8个月和28个月。非癌死亡30例,平均生存期52.6个月。结论:据国内外文献报告IDPC的发病率逐年增加。IDPC患者术后生存期与病理分级直接相关。本组Mostofi′sI级患者中未发现有因癌死亡者,5年生存期达50.0%,3年生存期达75.0%;Mostofi′sⅢ级患者中5例因癌死亡,5年生存期为0,3年生存期仅为40.0%;Mostofi′sⅠ级和Ⅱ级患者,其5年生存期分别为33.3%和29.0%,3年生存期分别为75.0%和74.2%。IDPC的后继治疗应考虑多种因素,其主要应是患者的病理分级与预期寿命,其次是患者的经济情况和心理因素。睾丸切除术应为首选治疗方法。对Mostofi′sⅢ级和Ⅱ级患者,预期寿命在5年以上者,可争取施行前列腺癌根治术。

Objective： To analyze the clinical features, treatment, and prognosis of incidental prostate carcinoma （IDPC） after surgery for benign prostatic hyperplasia （BPH） and to investigate the relationship between pathological grade and patient survival. Methods： Data from 1,510 patients with BPH who underwent transurethral resection of the prostate （TURP） or prostatectomy from January 1982 to December 2006 were retrospectively analyzed. Sixty-eight patients were diagnosed with IDPC. According to Mostofi＇s rating system, there were 24 grade Ⅰ cases, 34 grade Ⅱcases, and 10 grade cases. Testicle resection was performed in 56 cases. Testicle resection combined with endocrine therapy was performed in 48 cases. Six cases received endocrine therapy alone. Six cases received no adjunct treatment. Results： Of the 68 patients, 65 were followed up for 1 to 10 years： 3 patients failed to be followed up. Nine cases died of IDPC, including 2 Mostofi＇s grade Ⅲ cases and 4 Mostofi＇s grade Ⅱcases, with an average survival of 20.8 months and 28 months, respectively. Thirty cases died from unrelated causes, with an average survival of 52.6 months. Conclusion： The survival of patients with IDPC is coixelated with pathological grade. Factors including pathological grade and expected survival should be considered in treating patients with IDPC. Testicle reseelion is recommended for Mostofi＇s gradeⅢand grade Ⅱ patients. For those patients with an expected survival of more than 5 years, radical prostateetomy is an effective treatment.