减瘤性前列腺癌根治术联合内分泌治疗在寡转移前列腺癌患者中的疗效及预后观察

Efficacy and prognosis of cytoreductive radical prostatectomy combined with androgen deprivation therapy for oligometastatic prostate cancer

目的 探讨减瘤性前列腺癌根治术(cytoreductive radical prostatectomy,CRP)联合内分泌治疗(androgen deprivation therapy,ADT)在寡转移前列腺癌中的手术效果及预后。方法 纳入2015年6月至2021年3月收治的寡转移前列腺癌患者67例,32例行CRP联合ADT治疗(CRP组),35例行单纯ADT治疗(ADT组)。记录CRP组围手术期数据、两组进展至CRPC时间及肿瘤特异性生存期(cancer specific survival,CSS),运用Kaplan-Meier法比较。结果 两组(PSA)水平,Gleason评分,临床T、N分期差异无统计学意义。CRP组Clavien-DindoⅠ级并发症2例,Ⅱ级并发症9例,并发症发生率为34.38%。CRP组20例进展至CRPC,中位进展时间为26个月,ADT组21例进展至CRPC,中位进展时间为19个月。两组激素依赖性生存期差异有统计学意义(P <0.001)。Cox多因素回归分析显示CRP是延长寡转移前列腺癌进展至CRPC的独立保护因素(HR=0.276,95%CI:0.136~0.558,P <0.001)。两组CSS差异无统计学意义(P=0.452)。结论 CRP联合ADT治疗寡转移前列腺癌并发症较少,安全性好,与单纯ADT治疗相比,能延缓寡转移前列腺癌患者进展至CRPC的时间。

Objective To investigate the clinical outcomes of cytoreductive radical prostatectomy(CRP combined with androgen deprivation therapy(ADT)for oligometastatic prostate cancer.Methods A total of 67patients with oligometastatic prostate cancer were enrolled in the study from June 2015 and March 2021.Of the patients,32 were treated with CRP combined with ADT and 35 were treated with ADT alone.The perioperative outcomes were evaluated,the time to CRPC and cancer specific survival(CSS)were observed and compared by Kaplan-Meier method.Results No statistical differences in PSA levels,distribution of clinical tumor stage and nodal stage were noted between the two groups.The incidence of postoperative complications in CRP group was34.38%.Two patients experienced Clavien-Dindo I complications,while nine patients experienced Clavien-DindoⅡ complications.Tewnty patients progressed to CRPC in the CRP group and 21 in the ADT group.The median time to CRPC was significantly longer among the CRP group(26 months)compared with the ADT group(19 months).Multivariate analysis identified CRP as a significant predictor for delaying the progression to CRPC.There was no difference in CSS between the two groups.Conclusions CRP combined with ADT was effective in oligometastatic prostate cancer by delaying the progression to CRPC with few minor complications.