目的 评估前列腺癌根治术(RP)综合新辅助(NHT)及辅助治疗(AT)对局部控制及生存率的疗效.方珐 38例前列腺癌(Pca)患者,在RP前均行NHT,其中18例行辅助内分泌治疗及放疗,20例为对照组,两组临床病理特征及预后进行比较.结果 NHT后,PSA水平均明显下降(P=0.000),20(53%)例病理分期下降.AT组有较高的NHT前PSA、分期、Gleason评分、精囊侵犯及切缘阳性率(P＜0.05),随访7.6年,预后仍可与照组相比拟.5年及10年无生化复发率,AT组为75.9%,62.6%,对照组为78.8%,72.2%(P=0.635);无局部复发率,AT组均为88.5%,对照组均为94.4%(P=0.53);疾病特异生存率,AT组为93%,81.7%,对照组均为100%(P=0.114);整体生存率,AT组为87.5%,76.6%,对照组均为94.4%(P=0.234).结论 RP综合NHT及AT对局部控制及生存率可能得到明显的益处.%Objective To evaluate the effect of combined neoadjuvant hormonal therapy (NHT) and adjuvant therapy (AT) with radical prostatectomy (RP) on local control and survival rate. Methods Data of 38 patients with prostate cancer (Pca) , who were treated with NHT prior to RP, were retrospectively analyzed. Eighteen patients were treated with adjuvant hormonal therapy and radiotherapy immediately after RP and 20 were observed as controls. The risk features and follow-up outcome of the both groups were compared. Results After NHT, PSA level decreased significantly in all patients ( P =0.000). After RP. 20/38 (53％) patients presented decreased pathological stage. Patients treated with AT had a greater preNHT PSA level, Gleason score, T stage, seminal vesicle invasion and positive surgical margin (P＜ 0.05). During the followup of 7. 6 years, the 5-year and 10-year PSA-free survival was 75. g％ and 62. 6％ for patients treated with AT versus 78. 8％ and 72. 2％ for controls (P = 0. 635). There were similar results in local recurrence-free survival between the two groups (88. 5％ for AT patients versus 94. 4％ for controls. P= 0. 53) . Disease-free survival and overall survival of AT group were not significantly different compared with those of the control group ( P＞0. 05). Conclusions It might be concluded that the.combination of AT and NHT with RP is associated with significant clinical benefits in local control and survival advantage.
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