寡转移性前列腺癌根治术的临床初步疗效观察及围手术期并发症分析

摘要

背景与目的：多项回顾性研究显示，寡转移性前列腺癌根治术可以提高肿瘤的局部控制率和患者的总生存受益，围手术期并发症是影响寡转移性前列腺癌患者行前列腺癌根治术的一个重要因素。该研究旨在探讨寡转移性前列腺癌患者行前列腺癌根治术的临床初步疗效及围手术期并发症发生率和严重程度。方法：收集2015年7月—2016年1月247例前列腺癌根治术患者数据，其中寡转移性前列腺癌患者25例，局限性前列腺癌患者222例。两组均采用Clavien-Dindo手术并发症分级标准对出现并发症的患者进行分级。观察前列腺特异性抗原(prostate specific antigen，PSA)下降比例并将并发症发生率与严重程度在寡转移组和非寡转移组间进行对比分析。结果：寡转移组术后3个月时21例(84.0%)出现下降PSA,下降比例低于局限组212例(95.5%)，差异有统计学意义(P<0.05)。寡转移组共6例(24.0%)患者发生术后并发症，其中严重并发症(Ⅲ度及以上)1例(4.0%)，局限组共49例(22.1%)患者发生术后并发症，其中严重并发症(Ⅲ度及以上)7例(3.2%)，差异无统计学意义(P＞0.05)。结论：寡转移性前列腺癌患者行前列腺癌根治术治疗是安全、有效和可行的，并发症风险并非寡转移性前列腺癌患者行前列腺癌根治术的限制因素。%Background and purpose:It has been demonstrated that radical prostatectomy for patients with oligometastatic prostate cancer may contribute to improving local control of prostate cancer and overall survival by several retrospective studies. Perioperative complications play an important role in determining whether radical prostatectomy is appropriate for patients with oligometastatic prostate cancer. This study aimed to discuss the recurrence rate and the sever-ity of perioperative complications, and the primary curative effect of radical prostatectomy on oligometastatic prostate can-cer patients.Methods:A total number of 247 patients who received radical prostatectomy were recruited in the study from Jul. 2015 to Jan. 2016, including 25 patients with oligometastatic prostate cancer and 222 patients with localized prostate cancer. Patients with perioperative complications in both groups were graded with the Clavien-Dindo grading system. The proportion of PSA decline and the rates and severity of perioperative complications were analyzed in both groups.Results:The cases of prostate specific antigen (PSA) decline in the oligometastatic group were 21 (84.0%), lower than the localized group with 212 cases (95.5%). There were 6 cases (24.0%) with postoperative complications in the oligometastatic group, including serious complications (Ⅲ or above) 1 case (4.0%), and 49 cases (22.1%) with postoperative complications in the localized group, including serious complications (Ⅲ or above) 7 cases (3.2%). The differences between the groups reached no statistical significance (P>0.05).Conclusion:Radical prostatectomy for patients with oligometastatic prostate cancer could be safe, effective, and appropriate, the risk of perioperative complications should not be one of the limiting factors.