减瘤性根治性前列腺切除术对骨转移前列腺癌患者的临床疗效分析

doi:10.3969/j.issn.1006-7795.2021.06.011

首都医科大学学报 ›› 2021, Vol. 42 ›› Issue (6): 967-972.doi: 10.3969/j.issn.1006-7795.2021.06.011

• 前列腺疾病基础与临床研究 • 上一篇下一篇

减瘤性根治性前列腺切除术对骨转移前列腺癌患者的临床疗效分析

蒋铭心¹, 苏瑶², 熊天宇¹, 叶小波¹, 靳松³, 邢念增⁴, 金木兰⁵, 杨敏福^2*, 牛亦农^1,6*

1.首都医科大学泌尿外科研究所首都医科大学附属北京朝阳医院泌尿外科,北京 100020;
2.首都医科大学附属北京朝阳医院核医学科,北京 100020;
3.清华大学附属北京清华长庚医院泌尿外科,北京 102218;
4.中国医学科学院北京协和医学院肿瘤医院泌尿外科,北京 100021;
5.首都医科大学附属北京朝阳医院病理科,北京 100020;
6.首都医科大学附属北京世纪坛医院泌尿外科,北京 100038

收稿日期:2021-08-17 出版日期:2021-12-21 发布日期:2021-12-17
基金资助:
国家自然科学基金(81770754)。

The outcome of cytoreductive radical prostatectomy for prostate cancer patients with bone metastasis

Jiang Mingxin¹, Su Yao², Xiong Tianyu¹, Ye Xiaobo¹, Jin Song³, Xing Nianzeng⁴, Jin Mulan⁵, Yang Mingfu^2*, Niu Yinong^1,6*

1. Institute of Urology, Capital Medical University;Department of Urology, Beijing Chaoyang Hospital, Capital Medical University Beijing 100020, China;
2. Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;
3. Department of Urology, Beijing Tsinghua Changgeng Hospital, Tsinghua University, Beijing 102218, China;
4. Department of Urology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;
5. Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;
6. Department of Urology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China

Received:2021-08-17 Online:2021-12-21 Published:2021-12-17
Contact: * E-mail: minfuyang@126.com,18601020160@163.com
Supported by:
National Natural Science Foundation of China(81770754).

摘要/Abstract

摘要： 目的评估骨转移前列腺癌患者接受减瘤性根治性前列腺切除术的临床疗效。方法纳入首都医科大学附属北京朝阳医院泌尿外科2012年2月至2021年6月共计34例接受减瘤性根治性前列腺切除术的骨转移前列腺癌患者。回顾性分析患者的基线资料、围手术期指标以及预后情况,采用描述性统计分析、Kaplan-Meier法、单因素和多因素分析评估总生存期(overall survival,OS)及无生化进展生存期(biochemical progression-free survival,BPFS)。结果中位随访时间29.0个月,2年总生存率85.9%,中位无生化进展时间75.0个月,2年无生化进展率63.9%。术后1个月内9例患者出现Clavien-DindoⅠ～Ⅱ级并发症,术后3个月尿控基本恢复。骨转移灶数目≥5和＜5患者的BPFS分别为28.1个月和63.2个月(P=0.012),切缘阳性和阴性患者的BPFS分别为34.8个月和70.3个月(P=0.029),两组间差异具有统计学意义。多因素分析发现切缘阳性/阴性和无生化进展生存期显著相关(P=0.026)。结论前列腺癌骨转移不是手术的绝对禁忌。经过筛选和准备的患者行减瘤性根治性前列腺切除术是安全可行的,手术时间、失血量以及手术并发症在可接受范围之内。术后联合内分泌治疗等其他治疗,可有效控制血清前列腺特异性抗原(prostate specific antigen,PSA),有望改善疾病进展,延长生存期。

关键词: 前列腺癌, 骨转移, 减瘤手术, 根治性前列腺切除术

Abstract: Objective To evaluate the clinical efficacy of cytoreductive radical prostatectomy in prostate cancer patients with bone metastasis. Methods A total of 34 prostate cancer patients with bone metastasis were included in this study,who underwent cytoreductive radical prostatectomy in the Department of Urology, Beijing Chaoyang Hospital, Capital Medical University from February 2012 to June 2021. Overall survival(OS) and biochemical progression-free survival (BPFS) were evaluated using descriptive statistical analyses, the Kaplan-Meier method, and univariate and multivariate analyses. Results The median follow-up time was 29.0 months, the 2-year OS was 85.9%, the median biochemical progression-free time was 75.0 months, and the 2-year BPFS was 63.9%.9 patients suffered Clavien-DindoⅠ-Ⅱ level complications within 1 month after surgery,and the patients’ urination function was basically recovered at 3 months after surgery. There were statistically significant differences in mean BPFS between the number of bone metastasis ≥5 and <5 group (28.1 months vs 63.2 months, P=0.012),and the positive and negative margins group(34.8 months vs 70.3 months, P=0.029). Multivariate analysis showed that positive/negative surgical margins was significantly associated with BPFS(P=0.026). Conclusion Prostate cancer with bone metastasis is not an absolute operational contraindication. The cytoreductive radical prostatectomy is safe and feasible for the patients after screening and preparation, with acceptable operation duration, bleeding volume and postoperative complications. The serum prostate specific antigen can be effectively controlled via combination treatment with endocrine therapy and other treatments after surgery, which is expected to improve disease progression and prolong the length of survival.

Key words: prostate cancer, bone metastasis, cytoreductive surgery, radical prostatectomy

中图分类号:

R737.25

蒋铭心, 苏瑶, 熊天宇, 叶小波, 靳松, 邢念增, 金木兰, 杨敏福, 牛亦农. 减瘤性根治性前列腺切除术对骨转移前列腺癌患者的临床疗效分析[J]. 首都医科大学学报, 2021, 42(6): 967-972.

Jiang Mingxin, Su Yao, Xiong Tianyu, Ye Xiaobo, Jin Song, Xing Nianzeng, Jin Mulan, Yang Mingfu, Niu Yinong. The outcome of cytoreductive radical prostatectomy for prostate cancer patients with bone metastasis[J]. Journal of Capital Medical University, 2021, 42(6): 967-972.

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减瘤性根治性前列腺切除术对骨转移前列腺癌患者的临床疗效分析

The outcome of cytoreductive radical prostatectomy for prostate cancer patients with bone metastasis

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