近距离照射联合最大限度雄激素阻断治疗前列腺癌的疗效分析

摘要

目的 分析125I粒子近距离照射(BT)联合最大限度雄激素阻断(MAB)治疗对前列腺癌的治疗效果及并发症.方法 2012年9月至2016年9月经我院和苏州市立医院东区收治的前列腺癌患者资料中选取资料完整且随访时间不低于6个月、行胸部X线片或CT、腹盆腔CT或MRI及骨扫描排除转移病灶、原发肿瘤(T)分期T2～T3期的患者资料共109例,患者年龄50～89岁,前列腺体积11.73～122.10 mL,治疗前前列腺特异性抗原(PSA)4.16～189.10 ng/mL,Gleason评分6～10分.48例接受125 I粒子近距离照射治疗联合MAB治疗的患者纳入观察组,61例单纯MAB治疗者纳入对照组,两组患者一般资料均无统计学差异(P＞0.05),比较两组治疗后血前列腺特异性抗原(PSA)水平、生化无进展生存期(bPFS)及并发症.结果 两组患者治疗后血PSA水平均较治疗前明显降低(P＜0.001),观察组治疗9、12、18、24个月血PSA水平低于对照组(P＜0.05).治疗后观察组生化无进展生存时间(20.79±10.60)个月,明显长于对照组(16.10±10.87)个月(P=0.026).观察组术后下尿路刺激症状22例(45.83％),对照组尿路刺激症状者17例(27.87％),两组相比有统计学差异(P=0.041);两组均无严重并发症.结论 125I粒子近距离照射联合MAB治疗对前列腺癌患者疗效显著,创伤小、无严重并发症.%Objective To evaluate the outcomes and complications in prostate cancer patients who were treated with permanent iodine-125 brachytherapy (BT) combined with maximum androgen blockade (MAB).Methods The clinical data of 257 prostate cancer cases treated during Sept.2012 and Sept.2016 were retrospectively analyzed.The selection criteria were the following:follow-up ≥6 months;chest X-ray or CT,abdominal cavity CT or MRI and bone scan were conducted to exclude metastatic lesions;primary tumor (T) staging:T2-T3.A total of 109 cases were enrolled for further analysis,Aged from 50 to 89 years,Prostrate volume ranged from 11.73-122.10 mL,gleason score 6-10.Serum PSA from 4.16-189.10 ng/mL.48 patients undergoing iodine-125 BT combined with MAB serrved as the observation group,and another 61 cases treated with MAB as the control group.There was no statistical difference in the general data of the two groups(P＞0.05).The prostate specific antigen (PSA) level,biochemical progress-free survival (bPFS) and complications of the two groups were compared.Results The PSA level after treatment in the two groups was significantly lower than that before treatment (P＜0.001).The PSA level in the observation group was lower than control group for 9,12,18 and 24 months after treatment (P＜0.05).The bPFS in the observation group [(20.79±10.60)months] was significantly longer than that in the control group [(16.10±10.87) months](P =0.026).Low-urinary tract occurred in 22 cases (45.83 ％) in the observation group and 17 cases (27.87 ％) in the control group.There was a statistical difference between the two groups (P =0.041).No serious complications were observed during the follow-up.Conclusion The permanent iodine-125 brachytherapy combined with maximal androgen blockade is effective and minimal invasive to treat prostate cancer.