冷冻消融联合内分泌治疗T3期转移性前列腺癌的临床疗效及预后分析

Cryoablation combined with endocrine therapy for T3 stage metastatic prostate cancer: clinical efficacy and prognostic analysis

目的探讨冷冻消融(Cryo)联合内分泌治疗在改善T3期转移性前列腺癌预后的意义。方法回顾性分析103例初治T3期转移性前列腺癌患者临床资料,根据治疗方式不同分为冷冻消融联合内分泌治疗组和内分泌治疗组,内分泌治疗采用全雄激素阻断治疗(maximal androgen blockade,MAB),分析生存预后相关影响因素,比较两组生存预后差异。结果 44例(42.7%)患者接受冷冻消融联合内分泌治疗,59例(57.3%)接受内分泌治疗。预后影响因素分析结果显示:基线PSA≥50 ng/m L、Gleason评分≥8、PSA降至最低值时间(time to psa nadir,TTPN)≤9个月是总生存(overall survival,OS)预后独立危险因素,联合冷冻消融治疗是OS预后保护因素。合并骨转移、Gleason评分≥8、TTPN≤9个月、PSA最低值>1 ng/m L是无生化复发生存(biochemical recurrence free survival,b RFS)预后独立危险因素,联合冷冻消融治疗是b RFS预后保护因素。联合治疗组和内分泌治疗组平均TTPN分别为11.4个月和7.5个月(P=0.026)、平均PSA最低值分别为(0.99 ng/m L和1.71 ng/m L,P=0.008)、中位OS分别为80个月和51个月(P<0.001),中位b RFS分别为30个月和12个月(P<0.001)。结论与内分泌治疗比较,联合冷冻消融治疗可明显延长T3期转移性前列腺癌患者的OS和b RFS,改善患者预后。

Objective To explore the clinical value of cryoablation combined with endocrine therapy for T3 stage metastatic prostate cancer in improving the survival prognosis. Methods The clinical data of 103 patients with T3 stage metastatic prostate cancer who received initial treatment were retrospectively analyzed. According to the treatment methods, the patients were divided into cryoablation combined with endocrine therapy group （Cryo＋MAB group） and endocrine therapy group （MAB group）. Maximal androgen blockade was used as endocrine therapy. The related factors for survival prognosis were analyzed, and biochemical recurrence-free survival （bRFS） and overall survival （OS） were calculated by using univariate analysis and Cox regression multivariate analysis. The results were compared between the two groups. Results A total of 44 patients （42.7%） received cryoablation combined with endocrine therapy and 59 patients （57.3%） received endocrine therapy only. The results of prognostic influence factors analysis indicated that base-line PSA ≥50 ng/mL, Gleason score ≥8, time for PSA reducing to the lowest value （time to psa nadir, TTPN） ≤9 months were the independent prognostic risk factors for OS, and the combination use of cryoablation was a prognostic protective factor for OS. Bone metastasis, Gleason score ≥8, TTPN ≤9 months, the minimum value of PSA 〉1 ng/mL were the independent prognostic risk factors for bRFS, and the combination use of cryoablation was a prognostic protective factor for bRFS. Compared with MAB group, in Cryo＋MAB group the mean TrPN prolonged 3.9 months （11.4 vs. 7.5 months, P=0.026）, the average minimum value of PSA was decreased by 0.72 ng/mL （0.99 ng/mL vs 1.71 ng/mL, P=0.008）, the median OS prolonged 29 months （80 months vs 51 months, P〈0.001）, and the median bRFS prolonged 18 months （30 months vs 12 months, P〈 0.001 ）. Conclusion Compared with pure endocrine therapy, combination use of cryoablation and endocrine therapy can significantly prolong the OS and bRFS of patients with T3 stage metastatic prostate cancer, and improve the prognosis as well.