新辅助内分泌治疗联合前列腺癌根治术治疗高危前列腺癌的疗效

Efficacy of Radical Prostatectomy after Neoadjuvant Endocrine Therapy in High-risk Prostate Cancer

目的探讨高危前列腺癌患者行新辅助内分泌治疗(NHT)后接受腹腔镜下前列腺癌根治术(RP)的疗效。方法收集2014年5月-2017年6月就诊的高危前列腺癌患者72例,均经前列腺特异性抗原(PSA)检测、MRI检查和活检病理确诊。72例中,于NHT后行腹腔镜下RP 36例(观察组),单纯行腹腔镜下RP 36例(对照组)。比较两组患者的临床特征、围术期并发症、无生化复发率和5 a生存率。结果两组患者的年龄、初诊PSA值、Gleason评分、前列腺体积和临床分期比较,差别均无统计学意义(P>0.05)。观察组内分泌治疗后前列腺体积平均值由81.50 mL降至48.03 mL,术后病理降期率达86.11%。与对照组比较,观察组的手术时间缩短,术中失血量减少,两组差别均有统计学意义(P<0.05)。两组的肿瘤切缘阳性率、生化复发率和5 a生存率比较,差别均无统计学意义(P>0.05)。结论高危前列腺癌患者于NHT后行腹腔镜下RP,可缩小肿瘤体积、降低肿瘤分期,但不能提高患者的远期生存率和无生化复发率。

Objective To investigate the effect of laparoscopic radical resection of high risk prostate cancer after neoadjuvant endocrine therapy.Methods From May 2014 to June 2017,72 patients with high risk prostate cancer were selected.All patients were diagnosed with high risk prostate cancer by PSA test,MRI examination and biopsy pathology.36 patients with neoadjuvant endocrine therapy combined with laparoscopic radical prostatectomy were included in the observation group,and other 36 patients with laparoscopic radical prostatectomy alone were included in the control group.Clinical characteristics,perioperative complications,non-biochemical recurrence rate and 5-year survival rate of 2 groups were compared.Results There were no significant differences in age,initial PSA value,Gleason score,prostate volume and clinical stage between the two groups.After endocrine treatment,the mean prostate volume in the observation group decreased from 81.50 mL to 48.03 mL.The rate of postoperative pathological decline in the observation group was 86.11%.The operation time of the observation group was shorter than that of the control group,and the intraoperative blood loss of the observation group was less than that of the control group,and the difference between the two groups was statistically significant(P<0.05).There was no significant difference in biochemical recurrence and 5-year OS between the two groups.Conclusion Laparoscopic radical prostatectomy after neoadjuvant endocrine therapy can reduce the tumor volume and stage in high-risk prostate cancer patients,but it does not improve the long-term survival rate and non-biochemical recurrence rate.