前列腺偶发癌38临床分析

The clinical study of incidental prostatic carcinoma(report of 38 cases)

目的探讨前列腺偶发癌的临床分期、治疗方法选择与预后的相关性。方法回顾性分析2001—2007年良性前列腺增生术后发现的前列腺偶发癌患者38例,根据临床分期结果采用等待观察、手术去势、药物内分泌治疗及前列腺癌根治术等不同方式处理,并观察比较不同分期及相应治疗方法与预后的相关性。结果1240例良性前列腺增生手术患者中,术后检出前列腺癌38例(3.06%),T1a期16例,T1b期22例。随访6月—6年,存活率89.5%。T1a期等待观察组存活率90%,进展率10.0%;双侧睾丸切除术组存活率100%,进展率16.7%;T1a期总存活率93.8%,进展率12.5%。T1b期未行根治术组存活率81.3%,进展率37.5%;根治术组存活率为100%。与未行根治性术的T1b期相比,T1a期的总存活率高于T1b期,而进展率低于T1b期,但差异无统计学意义(P>0.05)。结论本组偶发癌检出率与报道相近。T1a期接受治疗组与等待观察组生存率相近;T1b期行双侧睾丸切除术加内分泌治疗者生存率仍低于T1a期,而进展率高于T1a期。T1b期行根治术的患者生存率高于未做根治术者。T1a期可等待观察,T1b期需积极治疗,对T1b期患者,根治性前列腺切除术可获得较好疗效。

Objective To study the correlation between stage, treatment and prognosis of incidental prostatic carcinoma. Methods Retrospective analysis 38 patients with incidental prostatic carcinoma who accepted operation for BPH during the period 2001-2007. According to the stage, treated these patients with watchful waiting, bilateral orchiectomy, endocrinotherapy with drugs and radical operation, then observed the correlation between stage, treatment and prognosis. Results 38 were diagnosed as prostatic carcinoma in 1240 cases after an operation for BPH, the rate was 3.06%. 16 of them was staged as T1a, 22 was staged as T1b. The period of follow-up was from 6 months to 6 years, the survival rate during the follow-up was 89%; to T1a patients accepted watchful waiting, the survival rate was 90%, and the rate of progress was 10%; to the patients accepted bilateral orchiectomy, the survival rate was 100%, and the rate of development was 17%; total survival rate of T1a was 94%, and total rate of development was 12.5%. To Tlb patients who had not accepted radical operation, the survival rate of which was 81%, and development rate was 37.5%; to those accepted radical operation, the survival rate was 100%. Compared with patients of Tlb had not accepted a radical operation, the total survival rate of T1a, was higher, and the rate of development was lower at the same time, however the difference was not significant in the statistic analysis（P〉0.05）. Conclusion The incidence of incidental prostatic carcinoma in BPH is similar to other reports. The survival rate of the T1a, patients accept endocrinotherapy is similar to those taking a watchful waiting. Although some T1b patients accept active endocrinotherapy, their prognosis still worse than that of T1a patients, However, the T1b patients accepting radical operation can get a excellent survival rate. So, to the T1a, patients, a watchful waiting is enough, but to the T1b patients, a radical operation is appropriate.