T3a期前列腺癌近距离治疗联合外放疗和内分泌治疗的疗效观察及预后因素分析

Outcomes and predictors of T3a prostate cancer treated by permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy

目的 探讨T3a期前列腺癌近距离治疗联合外放疗和内分泌治疗的疗效及预后影响因素.方法 2003年1月至2008年12月北京协和医院泌尿外科诊治T3a期前列腺癌患者38例,年龄48 ～ 84岁,平均71岁;前列腺特异性抗原（PSA） 10.000 ～99.800 μg/L,平均56.300 μg/L;Gleason评分5～9分,平均7.6分;穿刺活检针数阳性率10.0％～ 100％,平均65.3％.治疗方案为前列腺癌近距离治疗联合外放疗和内分泌治疗,观察患者联合治疗的效果,并运用Kaplan-Meier法绘制生存曲线.以患者术前年龄、前列腺体积、血清PSA值、Gleason评分和穿刺活检针数阳性率为变量,分别对生化复发、远处转移和总体生存状态行单因素分析.结果 38例患者随访9～ 109个月,平均69个月.19例出现生化复发,发生时间在术后1～ 40个月,平均13.4个月.13例出现远处转移,发生时间在术后1 ～ 70个月,平均19.7个月;15例死亡,9例死因为前列腺癌复发,6例为其他死因,平均死亡时间为术后52.2个月（9.0～98.5个月）.总体的5年无生化复发率、无远处转移率、肿瘤特异生存率及总体生存率分别为44.1％、68.6％、82.4％及75.8％.29例患者出现1～2级泌尿系统不良反应,18例患者出现1～2级胃肠道不良反应.在单因素分析中,穿刺活检针数阳性率对生化复发（x2=17.240,P=0.000）、远处转移（x2=18.641,P=0.000）及总体生存状态（x2=8.970,P =0.003）有显著影响;Gleason评分对远处转移（x2=12.484,P=0.000）和总体生存状态（x2=6.575,P=0.010）有显著影响;年龄对总体生存状态（x2=5.179,P=0.023）有显著影响.结论 近距离治疗联合外放疗和内分泌治疗是T3a期前列腺癌的可选择方案,穿刺活检针数阳性率是影响患者生化复发、远处转移及总体生存率的因素.

Objective To evaluate the outcomes of T3a prostate cancer treated by permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy,and analyse the influence of preoperative factors on prognosis.Methods From January 2003 to December 2008,38 pactients with T3a prostate cancer aged from 48 to 81 years （mean：71 years） were enrolled,with serum prostate specific antigen （PSA） levels ranged from 10.000 to 99.800 μg/L （mean：56.300 μg/L）,Gleason score from 5 to 9 （mean：7.6） and percentage of positive biopsy cores from 10.0% to 100% （mean：65.3%）.All patients were treated by permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy.Survival curves were calculated using the Kaplan-Meier method.The predictive factors including patient＆#39;s age,prostate volume,serum pre-treatment PSA,Gleason score and percentage of positive biopsy cores were used for univariate analysis on biochemical failure-free,distant metastasis-free and overall survival.Results The mean follow-up was 69 months （range：9-109 months）.Nineteen patients experienced biochemical failure.The average biochemical failure time was 13.4 months （range：1-40 months）.There were 13 patients developed as distant metastatic prostate cancer since average 19.7 months （range：1-70 months） after brachytherapy.Of all patients,9 died of prostate cancer recurrence,while 6 passed away because of other reasons,with an average of 52.2 months （range：9.0-98.5 months）.The 5-year biochemical failure-free survival （BFFS）,distant metastasis free survival （DMFS）,cancer specific survival （CSS） and overall survival （OS） rate were 44.1%,68.6%,82.4 and 75.8%,respectively.Twenty-nine patients experienced grade 1-2 gastrointestinal toxicity and 18 patients experienced grade 1-2 genitourinary toxicity.In univariate analysis,the percentage of positive biopsy cores was significantly correlated with BFFS （x2 =17.240,P =0.000）,DMFS （x2 =18.641,P =0.000） and OS （x2 =8.970,P =0.003） ; the Gleason score was significantly correlated with DMFS （x2 =12.484,P =0.000） and OS （x2 =6.575,P =0.010） ;and patient＆#39;s age was significantly correlated with OS （x2 =5.179,P =0.023）.Conclusions Permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy is alternative for T3a prostate cancer.The percentage of positive biopsy cores is correlated with BFFS,DMFS and OS.