腹腔镜前列腺癌根治术结合内分泌辅助方法治疗高危前列腺癌的初步研究

Primary research on laparoscopic radical prostatectomy combined with hormone therapy for high risk localized prostate cancer

目的评价腹腔镜前列腺癌根治术联合术前、术后内分泌辅助方法治疗局部高危前列腺癌的疗效。方法 2007年11月~2012年10月,在该院确诊为局部高危前列腺癌的患者46例,年龄62.5（37~75）岁;术前PSA 38.7（6.3~96.8）ng/mL。术前所有病例均行为期3~6个月的新辅助治疗,再接受腹腔镜前列腺癌根治术,术后所有病例均再行6个月以上的内分泌辅助治疗。运用SPSS 13.0软件对不同参数（包括术前PSA值、术后Gleason评分、病理分期和有无盆腔淋巴结转移）无生化复发生存率进行分析,采用Log.rank Test对患者Kaplan Meier曲线进行比较。结果 46例患者手术均获成功。术后Gleason评分7.7（6~10）。术后病理确诊盆腔淋巴结转移（LN＋）15例,淋巴结阴性（LN-）31例。术后随访时间37.5（6~63）个月,46例患者中有20例出现生化复发,其中LN（＋）组11例出现生化复发,而LN（-）组9例出现生化复发。46例患者5年无生化复发生存率及肿瘤特异生存率分别为56.5%（26/46）和97.8%（45/46）。结论腹腔镜前列腺癌根治术联合术前、术后内分泌辅助治疗可提高局部高危前列腺癌患者的5年无生化复发生存率和肿瘤特异性生存率,可有效控制疾病的进展。

[ Objective ] To evaluate the effect of laparoscopic radical prostatectomy combined with hormone ther- apy for the treatment of high risk localized prostate cancer. [Methods] 46 patients with high risk localized prostate cancer （HRLPC） who had undergone laparoscopie radical prostateetomy combined with neoadjuvant hormone therapy （before the operation） and adjuvant hormone therapy （after the operation） from January 2007 to December 2010 at our institution were studied. The median age （range） was 62.5 （37~75） of the patients, whose median PSA value （range） and Gleason score （range） were 38.7 （6.3~96.8） ng/mL and 7.7 （6~10）, respectively. SPSS 13.0 was carried out for statistical analyses .The clinical parameters （such as PSA, Gleason score , pT stage and lymph node status） were analyzed by Mann-Whitney U-test. The survival curves were plotted by the Kaplan-Meier method and differences were examined using the log-rank test. [ Results ] The operations were successful for all the 46 patients. The median （range） duration of the follow-up was 37.5 （6-63）. 15 cases of pelvic lymph nodes metastasis were con- firmed by the pathological diagnoses, 31 cases were founded negative lymph nodes. Biochemical relapses were oc- curred in 20 cases,of which 11 cases were lymph node positive and 9 cases were lymph node negative. The 5 years free biochemical relapse survival and overall survival rate were 56.5% （26/46） and 97.8% （45/46） respectively. [ Conclusion ] Laparoscopie radical prostateetomy combined with hormone therapy treatment of high risk localized prostate cancer might result in an improvement of 5 years biochemical relapse free survival and overall survival rate and delay the progress of the disease.