经尿道前列腺电切术治疗膀胱出口梗阻的前列腺癌患者的生存状况分析

Analysis on survival of patients after transurethral resection of prostate due to bladder outlet obstruction in patients with prostatic cancer

目的分析合并膀胱出口梗阻的前列腺癌患者行经尿道前列腺电切术后的生存状况并探讨其影响因素。方法回顾性收集2008~2015年于首都医科大学附属北京友谊医院行经尿道前列腺电切术的前列腺癌患者的病例资料并分析其生存状况,以肿瘤特异性死亡率及无失败生存期为主要研究终点,绘制生存曲线并采用Cox回归模型对其影响因素进行分析。结果共108例前列腺癌患者行经尿道前列腺电切术,包括92例术前已诊断前列腺癌患者及16例偶发前列腺癌患者。所有患者的中位年龄74岁,中位前列腺特异性抗原水平24.3 ng/ml,中位前列腺体积为54.9ml。中位随访65.5个月后,已诊断组的肿瘤特异性死亡率为60.9%(56/92),肿瘤特异性生存期为55个月。已诊断组及偶发组的无失败生存期分别为38个月及39个月。已诊断组的肿瘤特异性死亡率影响因素分别为Gleason评分(P=0.02)、临床分期(P=0.04)及远处转移(P=0.004),无失败生存期影响因素为临床分期(P=0.03)、远处转移(P=0.004)。偶发组的无失败生存期影响因素为年龄(P=0.03)及远处转移(P=0.004)。结论合并膀胱出口梗阻的前列腺癌患者原发肿瘤的相关特征会影响经尿道前列腺电切术后的肿瘤特异性死亡率。局部高危前列腺癌或远处转移前列腺癌患者的无失败生存期较短。对于偶发癌,年龄及Gleason评分为无失败生存期的独立预测因素。

Objective To analyze the survival status of patients with prostate cancer （PCa） after transurethral resection of prostate （TURP） due to bladder outlet obstruction （BOO） and to determine the prognostic factors. Methods The clinical data of patients with prostate cancer underwent TURP in this hospital during 2008 to 2015 were retrospectively collected and analyzed. PCa - specific mortality （PCSM） and failure - free survival （FFS） represented the primary endpoint caused by disease characteristics were analyzed by using Kaplan - Meier and COX proportional hazard regression analyses. Results The data of 108 patients with TURP including 92 patients had been diagnosed previously as PCa and 16 incidentally found were retrospectively collected and reviewed. The average age of these patients with TURP was 74 years old, the median level of prostate - specific antigen was 24.3 ng/ml, and median prostate volume was 54.9 ml. The avereLge follow - up period was 65.5 months, and the PCSM was 60.9% in patients with this diagnosis and median PCa - specific survival period was 55 months. Median FFS was 38 months in diagnosed cohort and 39 months in incidental cohort. The multivariate analysis demonstrated that PCSM was ini]uenced by Gleason scores （ P = O. 02） , clinical stage （ P =0.04） and distant metastases （P =0. 004）. FFS was influenced by clinical stage （ P =0.03） and dis/ant metastasis （ P = 0. 004 ） in diagnosed group, while age （ P = 0.04） and Gleason scores （ P = 0.03 ） in incidental group. Conclusion The characteristics of primary tumor may influence PCSM after TURP. Patients with locally advanced PCa or distant metastases may have worse FFS in diagnosed co- hort. For vatients with incidental PCa. ale and Gleason scores are univariate nroanostic factors.