探讨临床T4期前列腺癌新辅助内分泌治疗后行腹腔镜下前列腺癌根治术的临床研究

Clinical experience of laparoscopic radical prostatectomy for T4 prostate cancer after neoadjuvant therapy

目的探讨采用新辅助内分泌(NHT)治疗临床T4期前列腺癌最佳方案及在此之后行腹腔镜下前列腺癌根治术的临床应用价值。方法选取2015年1月至2018年12月南京医科大学附属淮安第一医院诊治的60例T4期前列腺癌患者临床资料作为研究对象。将行3个月~9个月NHT治疗后联合腹腔镜下前列腺癌根治术患者设为观察组(30例),接受穿刺检查后6周~8周行腹腔镜下前列腺癌根治术患者设为对照组(30例),比较两组患者基本临床特征及围手术期并发症情况。结果 NHT治疗后观察组患者PSA降低至0.01 ng/mL^7.43 ng/mL,PSA(0.99±0.17)ng/mL,与治疗前比较差异具有统计学意义(P<0.05)。术后3个月复查观察组患者PSA均低于0.01ng/mL,与对照组患者比较下降明显,差异具有统计学意义(P<0.05)。所有病例均经腹腔镜下顺利完成,观察组平均手术时间与平均出血量与对照组差异无统计学意义(P>0.05)。观察组术后病理变化与对照组比较,差异具有统计学意义(P<0.05);观察组Gleason评分、切缘阳性比例、盆腔淋巴结转移比例、术后并发症发生率与对照组差异无统计学意义(P>0.05)。所有患者均获随访,随访时间3个月~30个月,观察组2例出现生化复发,对照组3例出现生化复发,两组均无局部复发及远处转移。结论 NHT治疗后使T4期前列腺癌患者获得手术机会,手术安全、有效。对PSA<100 ng/mL、100ng/mL<PSA <200ng/mL及PSA>200ng/mL的患者大约分别需要4个月、5个月和6个月NHT治疗后适合行手术治疗。

Objective To explore the optimal application of neoadjuvant hormonal therapy(NHT) in the treatment of clinical T4 stage prostate cancer and the clinical value of laparoscopic radical prostatectomy. Methods Retrospective analysis of the clinical data of 60 patients with newly diagnosed T4 stage prostate cancer was performed. Patients who underwent laparoscopic radical prostatectomy after 3 to 9 months of NHT treatment were enrolled into the observation group(n=30), and patients received laparoscopic radical prostatectomy at 6~8 weeks after puncture examination were selected as the control group(n=30). The basic clinical features and perioperative complications were compared between the two groups. Results After NHT, the PSA in the observation group decreased to 0.01-7.43 ng/mL, with an average of 0.99±0.17 ng/mL, with statistically significant difference from that before treatment(P<0.05). The PSA of the observation group was lower than 0.01 ng/mL at 3 months after operation, which was significantly lower than that of the control group(P<0.05). Differences in the average operation time and mean volume of blood loss between the two groups were not statistically significant(P>0.05). The pathological changes in the observation group were significantly different from those in the control group(P<0.05). There was no statistically significant difference in the Gleason score, the proportion of positive margin, the proportion of pelvic lymph node metastasis, and the postoperative complication rate between the two groups(P> 0.05). All the patients were followed up for 3 to 30 months. Two patients in the observation group showed biochemical recurrence, and 3 patients in the control group showed biochemical recurrence. There were no local recurrence and distant metastasis in the two groups. Conclusions Surgical therapy of primarily inoperable prostate cancer is feasible and safe after NHT. 4 months′, 5 months′ and 6 months′ treatment of NHT is suitable for patients with PSA<100 ng/mL, 100 ng/mL<PSA <200 ng/mL and PSA>200 ng/mL accordingly.