初诊骨转移的前列腺癌患者局部治疗的疗效分析

Analysis of the efficacy of local treatment in prostate cancer patients with bone metastasis at first diagnosis

目的分析前列腺癌骨转移患者局部治疗的疗效。方法回顾性分析2014年1月至2021年12月于苏州大学附属第一医院就诊的211例初诊骨转移的前列腺癌患者资料。根据是否接受局部治疗,将患者分为全身治疗组、联合局部治疗组。其中,联合局部治疗组根据治疗方式,分为前列腺切除术组、前列腺根治性放疗组。根据是否接受放疗,分为放疗组、未放疗组。使用SPSS 26.0进行统计学分析,用Kaplan-Meier法和log-rank检验分析比较不同分组患者的生存差异,进行倾向评分匹配后重复比较。将患者的临床特征及治疗因素纳入Cox比例风险回归模型,分析其与患者生存之间的关系。结果相较于全身治疗组,联合局部治疗组患者的5年临床无进展生存(CPFS)率、5年总生存(OS)率明显提高(P=0.049、0.010);倾向评分匹配后,联合局部治疗组的5年生化无进展生存(BPFS)及5年OS率均优于全身治疗组(P=0.036、0.029)。局部治疗的前列腺切除术组与根治性放疗组间的5年BPFS、CPFS、OS率差异没有统计学意义。相较于未放疗组,放疗组患者的5年BPFS、5年OS率均明显提高(P=0.030、0.020);倾向评分匹配后,放疗组5年BPFS和5年OS仍显著高于未放疗组(P=0.046、0.047)。总体而言,接受放疗的患者耐受情况良好,未出现严重的放疗相关不良反应。对于年龄>65岁、骨转移局限于盆腔、Gleason评分≤8分的骨转移前列腺癌患者,放疗组的5年OS率明显高于未放疗组(P=0.039、0.024、0.036)。结论局部治疗,尤其是放疗可以提高初诊骨转移的前列腺癌患者的BPFS及OS率。放疗在高龄、骨转移局限于盆腔及Gleason评分相对低的患者中,效果似乎更为显著。

Objective To evaluate clinical efficacy of local treatment for prostate cancer patients with bone metastases at the initial diagnosis.Methods Clinical data of 211 prostate cancer patients with bone metastases at the initial diagnosis admitted to the First Affiliated Hospital of Soochow University from January 2014 to December 2021 were retrospectively analyzed.All patients were divided into the systemic and combined local treatment groups according to whether they received local treatment or not.Patients in the combined local treatment group were further divided into the prostatectomy and radical radiotherapy groups.According to whether they received radiotherapy,they were divided into the radiotherapy and non-radiotherapy groups.Statistical analysis was performed by SPSS 26.0 statistical software.The differences in the survival of patients among different groups were analyzed and compared by Kaplan-Meier method and log-rank test.The comparison was repeatedly conducted after the propensity score matching.Clinical characteristics and treatment factors of patients were included in Cox's proportional hazard regression model,and their relationship with survival was analyzed.Results Compared with systemic treatment,local treatment significantly improved the 5-year clinical progression-free survival(CPFS)and 5-year overall survival(OS)(P=0.049,0.010).After propensity score matching was performed,patients in the local treatment group outperformed those in the systemic treatment in 5-year biochemical progression-free survival(BPFS)and 5-year OS(P=0.036,0.029).There were no statistically significant differences in 5-year BPFS,CPFS and OS between the prostatectomy and radical radiotherapy groups.Radiotherapy improved 5-year BPFS and 5-year OS compared with non-radiotherapy(P=0.030,0.020).After propensity score matching was performed,5-year BPFS and 5-year OS in the radiotherapy group remained significantly higher than those in the non-radiotherapy group(P=0.046,0.047).Overall,patients who received radiotherapy were well tolerated and did not experience serious radiation-related adverse events.Radiotherapy improved 5-year OS for patients who were older than 65 years,had bone metastases confined to the pelvis and had a Gleason score of≤8(P=0.039,0.024,0.036).Conclusions Local treatment,especially radiotherapy,prolongs BPFS and OS rates in prostate cancer patients with bone metastases at first diagnosis.Radiotherapy appears to be more effective in patients of advanced age,with bone metastases confined to the pelvis and with relatively low Gleason scores.