^(125)I粒子植入联合全雄激素阻断治疗初诊寡转移性前列腺癌的疗效分析

Clinical efficiency of ^(125)I seed implantation combined with complete androgen blockade for newly diagnosed oligometastatic prostate cancer

目的:探讨^(125)I粒子前列腺组织间植入近距离放射治疗(BT)联合全雄激素阻断(CAB)临床用于治疗初诊寡转移性前列腺癌患者的有效性。方法:回顾性分析2009年1月～2016年1月收治的77例寡转移性前列腺癌患者的治疗及随访资料。其中BT+CAB治疗组40例,单纯CAB治疗组37例。两组患者中位随访时间均为49个月。随访期间每月监测血清PSA及睾酮水平,记录PSA最低值及到达最低值的时间。每6个月行盆腔MR及ECT全身骨扫描检查,记录疾病出现进展的时间。Kaplan-Meier法分别绘制两组患者的疾病无进展生存曲线和总生存曲线,并进行生存比较。对可能影响BT+CAB治疗组患者疾病进展的临床病理指标进一步行多因素分析。结果:BT+CAB治疗组和CAB治疗组患者的PSA最低值分别为(0.31±0.43)ng/ml和(0.57±0.72)ng/ml,两组差异无统计学意义(P>0.05)。BT+CAB治疗组患者PSA达到最低值的时间明显要长于CAB治疗组[(7.38±1.60)个月vs.(6.73±1.15)个月,P<0.05]。两组患者的5年总生存率分别为71.63%和58.11%,但Log-rank检验显示两组总体生存曲线比较差异无统计学意义(P>0.05)。BT+CAB治疗组患者的无进展生存状况明显优于CAB治疗组(P<0.05),两组的中位无进展生存期分别为41个月和33个月,3年无进展生存率分别为58.04%和35.51%。Cox多因素分析显示Gleason评分和PSA最低值是BT+CAB治疗组患者发生疾病进展的独立预测因子。结论:与单纯CAB治疗相比,BT+CAB治疗可以明显延缓初诊寡转移性前列腺癌患者的疾病进展,并取得一定的生存获益,这种联合治疗方法是安全有效的。Gleason评分(≥8分)和PSA最低值(≥0.4ng/ml)是寡转移性前列腺癌患者接受BT+CAB联合治疗后疾病进展的独立风险因素。

Objective:To evaluate the clinical efficiency of 125I seed implantation brachytherapy(BT)combined with complete androgen blockade(CAB)for men with newly diagnosed oligometastatic prostate cancer.Method:We analyzed retrospectively the data of 77 patients with newly diagnosed oligometastatic prostate cancer treated in our center from January 2009 to January 2016.Of these patients,40 were treated with BT added to CAB,other 37 with CAB alone.Median follow-up of the 2 groups were both 49 months.The level of PSA and testosterone were detected every month,the time to PSA nadir and the time to disease progression were recorded respectively.The progress-free survival curve and overall survival curve of two groups were acquired with Kaplan-Meier method and were compared with each other.COX regression analysis was applied to determine the influencing factors on disease progression in BT+CAB group.Result:PSA nadir of BT+CAB group and CAB group were(0.31±0.43)ng/ml and(0.57±0.72)ng/ml(P>0.05),time to PSA nadir of BT+CAB group was longer than that of CAB group[(7.38±1.60)months vs.(6.73±1.15)months,P<0.05].The 5-year overall survival(OS)rate was71.63%in BT+CAB group and 58.11%in CAB group,but no statistical significance of OS difference between 2 groups was found by log-rank test(P>0.05).The 3-year progress-free survival(PFS)rate was significantly higher in BT+CAB group(58.04%)than that in CAB group(35.51%),and longer median progress-free survival in BT+CAB group was found as well(41 months vs.33 months).The PFS curve of BT+CAB group was superior to CAB group(P<0.05).Gleason score and PSA nadir were both independent predictors of PFS in BT+CAB group.Conclusion:Compared to those treated with CAB alone,disease progression can be delayed obviously in patients with oligometastatic prostate cancer treated with BT+CAB.OS benefit may be expected in patients treated with BT+CAB which is safe and effective.Risk factors independently associated with decreased PFS in oligometastatic patients undergoing BT+CAB include Gleason score(≥8)and PSA nadir(≥0.4 ng/ml)