近距离治疗联合外放射治疗及内分泌治疗对局部高危前列腺癌的疗效

摘要

Objective To evaluate the effectiveness of brachytherapy combined with external beam radia -tion therapy and hormonal therapy in treating localized high-risk prostate cancer patients .Methods We retro-spectively analyzed 132 prostate cancer patients treated with brachytherapy from December 2003 to December 2007 in Department of Urology , Peking Union Medical College Hospital , including 97 localized high-risk pa-tients, and 35 localized low-to intermediate-risk patients.Postoperative prostate specific antigen ( PSA) level was monitored regularly in follow-up visits.Biochemical relapse , progression to castration-resistant prostate canc-er (CRPC) or metastasis, and deaths were documented .Biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) of the patients were evaluated .Results The bPFS, CSS, and OS of the 132 patients were 83.3%, 91.7%, and 84.8%, respectively;those indexes of the 97 localized high-risk patients were 81.4%, 88.7%, and 81.4%, respectively;and those of the 35 localized low-to inter-mediate-risk patients were 88.6%, 100%, and 94.3%, respectively .No significant difference was observed in bPFS and OS between high-risk and low-to intermediate-risk patients ( P=0.433 , 0.098 ) , while CSS was sig-nificant higher in low-to intermediate-risk patients than in high-risk patients ( P=0.037 ) .After patients were grouped based on Gleason score, tumor-node-metastasis (TNM) clinical stage, or preoperative PSA levels, differences in bPFS among groups were not statistically significant ( P=0.084 , 0.537 , 0.850 ) .Conclusion Brachytherapy combined with external beam radiation therapy and hormonal therapy may effectively control PSA level and delay biochemical relapse in localized high-risk prostate cancer .%目的：研究近距离治疗联合外放射治疗及内分泌治疗对局部高危前列腺癌的疗效。方法2003年12月至2007年12月北京协和医院泌尿外科收治前列腺癌近距离治疗患者132例，其中局部高危患者97例，局部中、低危患者35例。通过门诊随访，监测患者术后血清前列腺特异性抗原（prostate specific antigen， PSA）水平，记录患者出现生化复发、进展至去势抵抗性前列腺癌（castration-resistant prostate cancer， CRPC）或肿瘤远处转移、死亡等事件，了解患者无生化复发生存率（biochemical progression-free survival， bPFS）、疾病特异性生存率（cause-specific survival， CSS）及总体生存率（overall survival， OS）。结果132例患者 bPFS、 CSS、 OS 分别为83.3％、91.7％、84.8％，局部高危患者为81.4％、88.7％、81.4％，局部低、中危患者为88.6％、100％、94.3％。局部高危患者bPFS及OS与局部低、中危患者相比差异无统计学意义（P＝0.433，0.098）；而局部低、中危患者CSS明显高于局部高危患者（P＝0.037）。按不同Gleason评分、 TNM临床分期、术前PSA水平分别分组，各组患者间bPFS差异均无统计学意义（P＝0.084，0.537，0.850）。结论对于局部高危前列腺癌患者，近距离治疗联合外放射治疗或内分泌治疗可有效控制PSA水平并延缓生化复发。