近距离放射治疗对前列腺癌患者生存预后的影响

Long-term outcomes of prostate cancer patients treated with combined brachytherapy and maximal androgen blockade

目的 探讨影响前列腺癌（PCa）患者生存预后的临床因素,以及近距离治疗在改善PCa患者生存状况方面的临床意义.方法 回顾性总结近12年来289例PCa患者的临床病理资料及生存资料,分析可能影响患者生存预后的临床因素,并进一步比较单纯内分泌治疗方案与内分泌联合近距离治疗方案对患者生存率的影响.结果 全组患者中位生存时间73（7～144）个月,1、3和5年生存率分别为93.1%、81.0%和60.2%.单因素分析显示：前列腺体积、基线前列腺特异抗原（PSA）水平、Gleason评分、肿瘤分期、PSA下降时间、PSA最低值以及治疗分组（是否联用近距离治疗）是影响PCa患者生存时间的预后因素.多因素分析显示：Gleason评分、肿瘤分期、PSA最低值以及治疗分组（是否联用近距离治疗）是独立的预后因素.内分泌联合近距离治疗组患者的生存曲线与单纯内分泌治疗组患者的生存曲线相比差异有统计学意义,前组患者的5年累积生存率显著高于后组患者（68.7% 与41.8%,P=0.003）.结论 是否联合近距离治疗不仅与Gleason评分、肿瘤分期以及治疗后PSA最低值等因素一样,是PCa患者的独立预后因素;而且在内分泌治疗前进行近距离治疗能够显著延长PCa患者的生存周期.

Objective To explore the prognostic factors of prostate cancer （PCa） patients and evaluate the effect of brachytherapy on survival time. Methods A total of 289 PCa were recruited to collect their clinical and survival data. And their possible prognostic factors were analyzed. A further comparison of 5-year cumulative survival rate was made between the patients treated by maximal androgen blockade （MAB） and those on MAB plus brachytherapy. Results Their median survival time was 73 （7 - 144） months. And the 1, 3 and 5-year survival rates were 93.1%, 81.0% and 60. 2% respectively. Univariate analysis indicated that prostate volume, basal level of prostate-specific antigen （PSA）, Gleason score, tumor stage, PSA nadir, time PSA decreasing to nadir and brachytherapy were all predictive factors for survival time. And multivariate analysis further demonstrated that Gleason score, tumor stage and PSA nadir were independent prognostic indicators. And the combination therapy based on brachytherapy could significantly increase the 5- year cumulative survival rate than MAB-based monotherapy. Conclusion Gleason score, tumor stage and PSA nadir may predict the prognosis of PCa patients. And brachytherapy significantly improves patient survival.