经尿道姑息性前列腺切除术联合内分泌治疗对晚期前列腺癌合并膀胱出口梗阻的疗效分析

The effects of palliative transurethral surgery combined with hormonal therapy for metastatic prostate cancer with bladder outlet obstruction

目的探讨经尿道姑息性前列腺切除术对晚期前列腺癌合并膀胱出口梗阻患者的临床疗效及预后。方法将符合本研究要求的前列腺癌患者181例分为单纯内分泌治疗组(对照组)和经尿道姑息性前列腺切除术联合内分泌治疗组(手术组)。通过比较手术组术前、术后国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、残余尿(PVR)和前列腺癌治疗功能评价量表(FACT-P)评分来评估短期疗效;通过两组间比较,分析经尿道姑息性前列腺切除术对晚期前列腺癌患者无进展生存期(PFS)及总生存期(OS)的影响结果纳入研究的181例患者中73例因膀胱梗阻或反复血尿而行经尿道前列腺电切或激光手术,108例为单纯内分泌治疗。两组患者的年龄、治疗前血清PSA浓度、治疗前前列腺体积、Gleason评分、基础疾病及基线FACT-P评分比较,差异无统计学意义。随访4~91个月,中位随访时间34个月。手术组术后1个月IPSS(12.74±3.43)、Qmax(18.23±2.26)ml/s、PVR(27.41±8.28)ml、FACT-P评分(124.33±14.00)与术前比较均有改善,且P<0.05。手术组治疗后PSA谷值较对照组低(1.77ng/ml vs 3.14ng/ml,P=0.000),手术组PSA PFS较对照组长(20.10个月vs 12.58个月,Log-rank P=0.002),手术组影像学PFS较对照组长(21.40个月vs 14.31个月,Log-rank P=0.004),差异均有统计学意义。手术组OS较对照组长(53.31个月vs 45.08个月,Log-rank P=0.028),差异有统计学意义。是否手术、治疗前血清PSA浓度、基线及治疗后FACT-P评分是总体生存率的独立影响因素。结论经尿道姑息性前列腺切除术联合内分泌治疗可有效改善晚期前列腺癌膀胱出口梗阻症状,并可延缓疾病进展、延长患者OS,是晚期前列腺癌合并膀胱出口梗阻的一种安全有效的治疗方法。

Objective To investigate the effects of palliative transurethral surgery combined with hormonal therapy in treatment of metastatic prostate cancer with bladder outlet obstruction（BOO）. Methods One hundred and eighty-one patients with metastatic prostate cancer were divided into surgical group and control group.Clinical data of all the patients were analysised retrospectively.To assess the short-term effects of surgery by comparing the IPSS,Qmax,PVR and functional assessment of cancer therapy-prostate instrument（FACT-P）at baseline and after operation.To assess the long-term effects of the palliative transurethral surgery by comparison of PFS and OS between the two groups. Results One hundred and eighty-one patients were enrolled for further analysis.Among which,73 patient received transurethral surgery for a relief of BOO combined with maximum androgen blockade therapy.One hundred and eight patients treated with androgen deprivation therapy at the age of diagnosis.The medium follow up was 34 months（range 4-91 months）.Between two groups,total PSA value,prostate volume,prostate biopsy Gleason score,complications and the base-line score of FACT-P had no statistic difference.In the surgical group,patients have better IPSS（12.74±3.43）,Qmax（18.23±2.26）ml/s,PVR（27.41±8.28）ml,FACT-P（124.33±14.00）one month after the surgery than those at baseline（P〈0.05）.Patients in the surgical group had a lower PSA nadir（1.77 ng/ml vs 3.14 ng/ml,in average,P=0.000）,had longer time of PSA progression-free survival（PSA PFS）（20.10 months vs 12.58 months,Log-rank P=0.002）,and had longer time of radiographic progression-free survival（rPFS）（21.40 months vs 14.31 months,Log-rank P=0.004）.The surgical group also had a longer time of over survival（53.31 months vs 45.08 months,Log-rank P=0.028）.Multiple variant regression analysis showed that the treatment method,total PSA and FACT-P score value were independent determinants for overall survival. Conclusions Palliative transurethral surgery combined with hormonal therapy can relieve BOO symptoms in patients with advanced prostate cancer.And it may delay the progression of the disease and prolong the OS.It is a safe and effective therapy for the patients with metastatic prostate cancer accompanied by BOO.