经尿道前列腺等离子剜除术后前列腺偶发癌42例临床分析

Analysis of incidental prostatic carcinoma in 42 cases after transurethrai plasmakinetic enucleation of prostate

目的探讨前列腺偶发癌的临床分期、治疗方案选择与预后之间的相关性。方法回顾性分析2004至2010年因良性前列腺增生（BPH）行经尿道前列腺等离子剜除（TuPKEP）术1076例临床资料，发现前列腺偶发癌42例，观察比较不同分期及相应治疗方法与预后的相关性。结果1076例行TUPKEP手术患者中，术后发现前列腺偶发癌42例（3．9％），年龄56～88岁，均为腺癌，T1a期18例，T1b期24例。行药物去势10例，手术去势14例，根治性前列腺切除术14例，观察等待4例。随访24～96个月：T1a期观察等待组存活率100．0％，进展率0．0％；药物＋手术去势组存活率100．0％，进展率20．0％；根治术组存活率100．0％，进展率0．0％。T1a期总存活率100．0％，进展率11．1％。T1b期药物＋手术去势组存活率71．4％，进展率42．9％；根治术组存活率为100．0％，进展率0．0％。T。b期总存活率83．3％，进展率25．0％。与T1b期相比，T1a期的总存活率高于Ttb期（x2=18．19，P〈O．01），而进展率低于T1b期（x2=6．52，P〈0．05）。结论T1a期接受治疗组与观察等待组生存率相近；T1b期行药物或手术去势组生存率仍低于T1a期，而进展率高于Tta期。T1b期行根治术的患者生存率高于未行根治术者。T1a期可观察等待，T1b期应积极治疗，对T1b期患者根治性前列腺切除术可获得较好疗效。

Objective To investigate the correlation of clinical stage and treatment plan with prognosis in incidental prostatic carcinoma. Methods From 2004 to 2010, a total of 1076 patients diagnosed as BPH underwent transurethral plasma kinetic enucleation of prostate （TUPKEP） in our hospital, and their clinical data were respectively analyzed. Among them, 42 cases were found to have incidental prostatic carcinoma. The correlation of clinical stage and treatment plan with prognosis in incidental prostatic carcinoma were observed. Results Among 1076 BPH patients undergoing TUPKEP operation, 42 cases （3.9%） aged 56-88 years were found to have incidental prostatic carcinoma, which all displayed as prostatic adenocarcinoma including 18 cases at T1 a stage and 24 cases at rl b stage. 10 cases received endocrinal therapy, 14 cases received bilateral orehiectomy, 14 cases underwent radical prostectomy and 4 cases were treated with watchful waiting. Patients were followed up for 24 to 96 months. The survival rates were 100.0% and the rates of progression were 0.0% ,20.0%, 0.0% in T1 a patients received watchful waiting, androgen-deprivation therapy and radical prostectomy, respectively. Total survival rate was 100.0% and total rate of progression was 11.1% in Tla patients. The survival rates were 71.4%, 100.0% and the rates of progression were 42.9%, 0.05% in T1 b patients received androgen-deprivation therapy and radical prostectomy, respectively. Total survival rate was 83.3% and total rate of progression was 25.0% in T1 b patients. Compared with T1 b patients,the total survival rate was higher （Z2 =18.19,P〈0.01） and the rate of progression was lower in Tla patients （g2 =6.52,P%0.05）. Conclusions The survival rate in T1a patients accepted androgen-deprivation therapy is similar to that in T1 a patients with watchful waiting. Compared with T1a patients, the survival rate is lower but the rate of progression is higher in T1b patients received active androgen-deprivation therapy. The survival rate is higher in T1 b patientstreated with radical prostectomy than in those received other treatments. Watchful waiting is acceptable for T1 a patients. T1 b patients should be treated with radical prostectomy for a better effect.