放射性粒子植入术治疗高分级前列腺癌的远期随访研究

Long-term outcomes of brachytherapy for high-grade prostate cancer

目的:探讨应用I125放射性粒子植入术治疗高分级非转移性前列腺癌的远期疗效和安全性。方法:回顾性分析2007年1月~2017年3月经病理确诊为前列腺癌且Gleason评分≥8分的高分级前列腺癌患者67例,年龄61~83岁,平均(74.2±4.8)岁;穿刺前PSA 5.6~117.0ng/ml,平均(27.6±22.8)ng/ml;穿刺Gleason评分8分者35例(52.2%),9~10分者32例(47.8%);临床分期T2期42例(62.7%),T3期25例(37.3%),所有患者均接受I125前列腺放射性粒子植入术作为初始治疗,术后均行辅助内分泌治疗,内分泌治疗时间为6~12个月,为激素全阻断疗法。生化进展定义为PSA大于治疗后最低值2ng/ml,随访患者无生化进展生存率、肿瘤特异性生存率和总体生存率。结果:所有高分级前列腺癌患者粒子植入手术均顺利完成,术后随访12~121个月,平均56.1个月。在随访过程中,33例(49.3%)高分级前列腺癌患者出现生化进展,平均生化进展时间为28.8个月;13例(19.4%)患者在随访过程中死亡,其中7例(10.1%)患者因前列腺癌进展死亡。本组患者3年无生化进展生存率、肿瘤特异性生存率和总体生存率分别为59.7%、94.9%和89.8%,5年无生化进展生存率、肿瘤特异性生存率和总体生存率分别为42.6%、91.5%和83.1%。Gleason评分8分与9~10分的高分级前列腺癌患者经粒子植入治疗后的无生化进展生存率Kaplan-Meier生存曲线比较差异有统计学意义(P<0.05)。结论:应用I125放射性粒子植入术治疗高分级前列腺癌患者安全、有效,值得推广,但应注意Gleason评分≥9分患者,临床进展更为迅速,在临床工作中应予以重视。

Objective：To investigate the long-term clinical value and safety of I125 particle implantation brachytherapy in treating high-grade non-metastatic prostate cancer.Method：We retrospectively analyzed 67 cases with Gleason score≥8 biopsy-proven non-metastatic prostate cancer from 2007 to 2017.The average age was（74.2±4.8）years old,and pre-biopsy PSA was（27.6±22.8）ng/ml.There were 35 cases（52.2%）of biopsy GS 8 and32 cases（47.8%）of biopsy GS higher than 8.There were 42 patients（62.7%）with clinical stage T2 and 25 patients（37.3%）with clinical stage T3.All patients were performed I125 particle implantation brachytherapy as initial treatment,adjuvant androgen deprivation therapy was used ranging from 6 to 12 months after the brachytherapy.Biochemical recurrence was defined as a PSA level of 2 ng/ml more than the nadir.Biochemical recurrence free survival,cancer specific survival and overall survival were calculated by the data of follow-up.Result：All highgrade patients were performed brachytherapy successfully.Over an average follow-up period of 56.1 months,49.3%（33/67）patients had a biochemical recurrence,the average biochemical progression time was 28.8 months.Thirteen cases（19.4%）were death during the follow-up period,and seven of them（10.1%）died of prostate cancer progression.The biochemical recurrence free survival rate,cancer specific survival rate and overall survival rate were 59.7%,94.9%and 89.8%in three years,42.6%,91.5%and 83.1%in five years respectively in high-grade prostate cancer patients.The biochemical recurrence free survival for men between Gleason score8 and Gleason score higher than 8 showed significant difference（（P〈0.05））according to Kaplan-Meier survival curve analysis.Conclusion：I125 particle implantation brachytherapy is an effective and safe method for clinical nonmetastatic high-grade prostate cancer.However,we should pay attention to prostate cancer patients with Gleason score higher than 8 for its rapid disease progression.