机器人辅助腹腔镜前列腺癌根治术联合新辅助内分泌治疗高危前列腺癌的临床研究

Clinical study of robot-assisted laparoscopic radical prostatectomy combined with neoadjuvant hormone therapy in treating high-risk prostate cancer

目的:探讨术前机器人辅助腹腔镜前列腺癌根治术(Robot-assisted laparoscopic radical prostatectomy,RALP)联合新辅助内分泌治疗(Neoadjuvant hormone therapy,NHT)治疗高危前列腺癌患者的临床疗效。方法:回顾性分析甘肃省人民医院泌尿外科自2018年6月-2020年12月前通过PSA、穿刺活检及MRI确诊的35例高危前列腺癌患者临床资料,其中术前行RALP+NHT治疗组25例,年龄为56~81(70.28±7.07)岁;RALP治疗组10例,年龄为49~86(69.20±8.77)岁。比较两组患者的手术时间、术中出血量、术后住院时间、术后切缘阳性率及术中和术后并发症等情况。结果:所有患者手术均获成功,无中转开放及二次手术。与RALP治疗组相比,RALP+NHT治疗组在手术时间[237.88±68.99d Vs (277±76.69)d,P=0.541]、术中出血量[(149.60±149.84)ml Vs (225±268.56)ml,P=0.266]、术后住院时间[(11±4.31) d Vs(11.7±4.86) d,P=0.402]、术后留置尿管时间[(28±6.81) d Vs (28±6.81) d,P=0.464]和术前PSA值[(49.97±32.22)ng/ml Vs (47.41±23.14)ng/ml,P=0.089]等方面差异均无统计学意义;RALP+NHT治疗组在总住院时间[(18.08±4.44)d Vs (25.5±10.82)d,P<0.005]和术后留置引流管时间[(10.12±3.36)d Vs(11.10±5.17)d,P=0.014]明显低于RALP组,差异具有统计学意义;RALP+NHT治疗组在Gleason评分(24%Vs10%)、肿瘤切缘阳性(12%Vs 20%)及并发症(4%Vs 10%)等方面下降明显。结论:术前RALP联合NHT可降低高危前列腺癌切缘阳性、改善病理分级,使高危患者受益。

Objective: To investigate the clinical benefits of robot-assisted laparoscopic radical prostatectomy(RALP)combined with neoadjuvant hormone therapy(NHT) in the treatment of high-risk prostate cancer. Methods: Retrospective study was conducted on 35 high-risk prostate cancer patients diagnosed by PSA, needle biopsy and MRI in the Department of Urology of Gansu Provincial People’s Hospital from June 2018 to December 2020. Among them, 25 patients [56 to 81(70.28±7.07) years old]were treated with NHT before operation, and 10 patients [49 to 86(69.20±8.77) years old] were treated with no NHT. The operation time, intraoperative blood loss, postoperative hospital stay, postoperative margin positive rate, positive rate of surgical margins,intraoperative and postoperative complications were compared between the two groups. Results: All surgeries were successfully completed. No conversion to open surgery or secondary surgery occurred. Differences between RALP group and RALP+NHT group on operation time [(237.88±68.99) min Vs(277±76.69) min, P=0.541], intraoperative blood loss [(149.60±149.84)ml Vs(225±268.56)ml, P=0.266], postoperative hospital stay [(11±4.31)d Vs(11.7±4.86)d, P=0.402], postoperative indwelling catheter time [(28±6.81)d Vs(28±6.81)d, P=0.464], and the preoperative PSA value [(49.97±32.22)ng/ml Vs(49.97±32.22) ng/ml, P=0.464] were not statistically significant. The total length of stay[(18.08±4.44)d Vs(25.5±10.82)d,P<0.005] and postoperative indwelling time of drainage tube [(10.12±3.36)d Vs(11.10±5.17)d, P=0.014] were significantly lower than that in the RALP group. Gleason score(24% Vs 10%), positive rate of surgical margins(12% Vs 20%) and complications(4% Vs 10%) were significantly lower than that in the RALP group. Conclusion: Preoperative RALP combined with NHT could reduce the positive margin of high-risk prostate cancer and improve the pathological grading to benefit high-risk patients.