腔镜下前列腺癌根治切除术与近距离放射治疗比较研究

Comparison of laparoscopic radical retropubic prostatectomy and brachytherapy for localized prostatic cancer: A prospective study

目的比较腔镜下耻骨后前列腺根治切除术(LRRP)和近距离放射疗法(BT)治疗局限性前列腺癌的疗效。方法从2005年4月至2009年4月间,前瞻性的收集和登记100例患者,平均年龄(65.9±8.9)岁,其中:A组50例患者接受LRRP,B组50例患者接受BT。治疗前和治疗后,分别对所有患者进行体格检查,测定前列腺特异性抗原和国际前列腺症状评分,IIEF-5评分和癌症患者生活质量调查问卷及前列腺癌特异性量表(EORTC-QLQ-C30/PR25)。并记录两种治疗方法术后5年无瘤存活率,及随访6个月、1年、5年的功能相关性结局指标。结果研究共纳入100例患者,其中87例完成了5年随访评估。LRRP和BT两种治疗方法术后5年无生化复发生存率分别为86.7%及88.1%。在随访至6个月和1年时,这两种治疗方法都导致患者的生活质量明显下降。B组患者尿路刺激症状发生率明显高于A组,且持续更久,但勃起功能较A组好。随访5年后,两组功能相关结局改变无明显统计学差异。结论 LRRP和BT是局限性前列腺癌的两种不同的治疗方法,二者的短期并发症,如尿路刺激症状和勃起功能障碍有所不同,但是,二者有着相似的5年生化无瘤存活率。因此,为进一步评估二者的总体有效率,我们需要开展更大样本量及更长随访时间的随机对照试验研究。

Objective To compare the therapeutic effect of laparoscopic radical retropubic prostatectomy（LRRP）and brachytherapy（ BT）for treatment of localized prostate cancer. Methods Between Apr. 2005 and Apr. 2009,100 patients were collected and registrated. A group of 50 cases of them accepted LRRP,B group of 50 cases of them accepted BT. Prior to and following treatment,all patients were evaluated by physical examination,including the test of prostate specific antigen,International Prostate Symptom Score,IIEF-5 scores,quality of life questionnaire and specificity scale（ EORTC-QLQ C30 /PR25）. 5-year biochemical disease-free survival,followed up at 6 months,1 year and 5 years of function outcome indicators were recorded for all patients. Results 87 cases of the included 100 patients completed 5-year follow-up assessment. The 5-year biochemical disease-free survival rate of LRRP and BT were 86. 7% and 88. 1% ,respectively. At 6 months and 1 year,both of them produced a significant decrease in the quality of life. The incidence of urinary irritation symptoms in group B was obviously higher and longer lasting than that in group A,but better erectile function reported in group B. There was no significant statistical difference in functional outcomes after 5 years between two groups. Conclusion LRRP and BT are two different methods for treatment of localized prostate cancer,the short-term complications,such as urinary irritation symptoms and erectile dysfunction are different,but the rates of 5-year biochemical disease-free survival are similar. Therefore,in order to further evaluate the overall effect of them, randomized controlled trials with larger sample sizes and longer follow-up are need.