前列腺癌根治术后精囊侵犯患者的临床资料分析

Clinical Analysis of Patients with Isolated Seminal Vesicle Invasion Post Radical Prostatectomy

目的:评估21例前列腺癌根治术后精囊侵犯患者的预后及其治疗影响因素。方法:回顾性分析2001～2006年行耻骨后前列腺癌根治性切除术的前列腺癌患者临床资料,术后定期门诊随访,其中21例术后病理检查提示单侧或双侧精囊侵犯,中位年龄70(48～79)岁;术前PSA<10 ng/ml 7例,10～20 ng/ml 9例,>20ng/ml 5例;Gleason分级2～6分3例,7分8例,≥8～9分10例。以根治术后连续2次PSA水平超过0.2 ng/ml定义为生化复发;以根治术后随访时发生生化复发或截止到随访时还没有发生生化复发的时间定义为无生化复发生存时间。术前PSA<10 ng/ml且Gleason分级为2～6分的患者进行等待观察治疗,Gleason分级≥7分或PSA≥10 ng/ml的患者接受单纯抗雄激素治疗、最大限度雄激素阻断治疗或最大限度雄激素阻断治疗+外放疗。结果:21例患者随访34～106个月,3例进行等待观察治疗,7例进行单纯抗雄治疗,6例进行最大限度雄激素阻断治疗,5例进行最大限度雄激素阻断+外放疗;其中1例发生骨转移,发展为激素难治性前列腺癌。21例患者无死亡。5年无生化复发存活时间在等待观察组、单纯抗雄激素治疗组、最大限度雄激素阻断治疗组及外放疗+最大限度雄激素阻断治疗组间的差异无统计学意义。结论:前列腺癌根治术后精囊侵犯者的预后尚可,Gleason分级≤6分、PSA水平低者可采取等待观察;PSA≥10 ng/ml且Gleason分级≥7分者术后给予辅助治疗可提高无生化复发生存率,且单纯抗雄激素治疗比最大限度雄激素阻断治疗和外放疗+最大限度雄激素阻断治疗经济、并发症少,生活质量高。

Objective： To assess the prognosis of 21 patients after radical prostatectomy with isolated seminal vesicle invasion and analyze the prognostic factors influencing the treatment option. Methods： From 2001 to 2006, the clinical data of the patients that were done radical retropubic prostatectomy were analyzed retrospectively, and the patients were followed up in out patient department regularly. 21 patients underwent radical prostatectomy were confirmed with seminal vesicle invasion by pathology, the median age was 70 ranging from 48 to 79 years old. There were 7, 9, 5 cases whose preoperative PSA were〈10 ng/ml, 10-20 ng/ml, 〉20 ng/ml respectively. 3 patientsr Gleason score were 2-6, 8 patients＇ Gleason score were equal to 7, 10 patients＇ Gleason score were≥ 8-9. Biochemical recurrence was defined as two consecutive PSA superior to 0.2 ng/ml after the surgery. Bio- chemical recurrence -free time was defined as the time from the date of the surgery to the date of the biochemical recurrence or to the last contact in non-recurring patients. Patients with preoperative PSA〈10 ng/ml and Gleason score 2-6 underwent received watchful waiting. Patients with preoperative PSA≥10 ng/ml or Gleason score≥7 received antiandrogen therapy, maximum androgen deprivation therapy（MAB） or MAB＋ radiotherapy. Results.. The median follow-up length of 21 cases was 34-106 months. Watchful waiting was accepted in 3 patients. 7 patients received antiandrogen therapy alone. 6 patients received maximum androgen deprivation therapy. 5 patients underwent MAB accompanied with radiotherapy; one of the 5 patients occurred with bone metastasis and developed into hormone refractory prostate cancer. There was no death case during follow up. No significant difference in biochemical recurrence-free time was found among the four groups in 5 years. The survival analysis showed that the biochemical recurrence free survival of the four groups had no statistical difference. Conclusions： Prognosis of patients with seminal vesicle invasion is acceptable. Patients with PSA〈10 ng/ml and Gleason score≤6 can receive watchful waiting. Postoperative adjuvant therapies were provided to the patients with preoperative〈10 ng/ ml and Gleason≥7 could improve the biochemical recurrence-free survival. Compared to MAB and MAB＋radiotherapy, antiandrogen therapy alone was more cost-effective and offered less complication and a higher quality of life.