本文選題：前列腺癌根治術　切入點：新輔助內(nèi)分泌治療　出處：《山東大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的 探討根治性前列腺切除術聯(lián)合術前新輔助內(nèi)分泌治療T3bN0M0期前列腺癌的治療效果和安全性。 材料和方法 通過回顧性總結分析自2008年1月至2013年5月,山東省立醫(yī)院泌尿外科共收治136例T3bN0M0前列腺癌患者的病例資料,根據(jù)治療方式的不同可分為以下三組,NHT組：恥骨后前列腺癌根治術聯(lián)合術前3個月新輔助內(nèi)分泌治療(MAB)的患者54例；RP組：術前診斷為cT2期而行恥骨后根治性前列腺切除術,手術之后病理學檢查發(fā)現(xiàn)為T3b期的患者38例；MAB組：未行根治術而單純行內(nèi)分泌治療(MAB)的患者44例,NHT組與RP組術后均繼續(xù)接受內(nèi)分泌治療(MAB)。治療前三組患者的基本情況(年齡、前列腺體積、PSA水平、Gleason評分)的差異無統(tǒng)計學意義(P0.05),通過對比分析NHT組與RP組患者的手術時間、失血量、切緣陽性率,術后尿管留置時間、患者控尿恢復時間、術后并發(fā)癥發(fā)生率,及通過電話隨訪、家訪或定期門診復查等隨訪方式比較新輔助內(nèi)分泌治療對前列腺癌根治手術的影響,比較三組患者的2年及5年無生化復發(fā)生存率、無局部復發(fā)生存率、疾病特異性生存率以及總生存率。 結果 NHT組及RP組患者手術均獲成功,NHT組和RP組的平均手術時間為(102.22±16.55)min和(96.03±17.80)min(P=0.378),術中平均失血量分別為(283.33±50.53)ml和(325.26±75.45)ml(P=0.022),術后切緣陽性率分別為20.37%和36.84%(P=0.08),術后平均尿管留置時間分別為(16.72±7.39)d和(17.34±6.49)d(P=0.678),三組患者隨訪(15-60個月)平均(40.65±14.40)月,除3例患者術后出現(xiàn)尿失禁外(NHT組2例、RP組1例),其余平均控尿恢復時間分別為(55.67±13.72)d和(60.84±15.17)d(P=0.01),NHT組術后出現(xiàn)尿道狹窄2例(3.7%),切口感染1例(1.9%),脂肪液化2例(3.7%),尿失禁2例(3.7%),其余無其他明顯并發(fā)癥,RP組術后出現(xiàn)尿道狹窄1例(2.6%),尿失禁1例(2.6%)、淋巴漏1例(2.6%)、切口感染1例(2.6%)、直腸損傷2例(5.2%)。NHT、RP和MAB組2年及5年的無生化復發(fā)率分別為(96.3%、87.04%)、(89.48%、68.43%)和(90.91%、70.46%)(2年P=0.104、5年P=0.036),NHT和RP組2年和5年的無局部復發(fā)率分別為(100%、96.30%)、和(97.37%、86.85%)(2年P=0.364、5年P=0.025),三組2年疾病特異性生存率均為100%,5年疾病特異性生存率則分別為98.15%、86.84%和84.10%(P=0.028),5年整體生存率分別為94.44%、84.21%和81.82%(P=0.099)。 結論 前列腺癌根治術聯(lián)合術前新輔助內(nèi)分泌治療T3bN0M0期前列腺癌是安全可行的,不增加手術風險,并可適當減少術中失血量。新輔助內(nèi)分泌治療能夠縮小前列腺體積、降低PSA水平,可以減少腫瘤切緣陽性率(特別是對于Gleason評分≤7的前列腺癌病例)并顯著提升患者5年無生化復發(fā)生存率、無局部復發(fā)生存率以及疾病特異性生存率,遠期效果佳。
[Abstract]:Purpose. To evaluate the efficacy and safety of radical prostatectomy combined with preoperative neoadjuvant endocrine therapy for stage T 3 N 0 M 0 prostate cancer. Materials and methods. From January 2008 to May 2013, 136 patients with T3bN0M0 prostate cancer were treated in Department of Urology, Shandong Provincial Hospital. According to the different treatment methods, 54 patients with retropubic prostate cancer treated with radical resection of retropubic prostate cancer combined with preoperative neoadjuvant endocrine therapy were divided into the following three groups: group RP: radical posterior pubic prostatectomy diagnosed as cT2 stage before operation. After operation, 38 patients with stage T3b were diagnosed as MAB group: 44 patients in NHT group and RP group continued to receive endocrine therapy after operation without radical operation but only with endocrine therapy. The basic condition (age, age, age) of the first three groups of patients (age, age, age, age, age, age, age, age, age, age, age, age, age, and age) of the three groups continued to receive endocrine therapy after surgery. There was no significant difference in PSA level and Gleason score between NHT group and RP group. The time of operation, the amount of blood loss, the positive rate of incision margin, the time of indwelling urethral catheter after operation, and the time of recovery of controlled urine were compared between NHT group and RP group. The incidence of postoperative complications and the effects of neoadjuvant endocrine therapy on radical prostatectomy were compared by telephone follow-up, home visit or regular outpatient reexamination. The 2-year and 5-year survival rates of the three groups were compared. Local recurrence free survival rate, disease specific survival rate and overall survival rate. Results. The average operative time of successful operation in NHT group and RP group was 102.22 鹵16.55 min and 96.03 鹵17.80 min / min respectively. The average blood loss during operation was 283.33 鹵50.53 ml and 325.26 鹵75.45 ml P0.022, respectively. The positive rate of incision margin was 20.37% and 36.844.45 ml P0.08 respectively. The mean time of indwelling urinary catheter after operation was 16.72 鹵7.39 days and 16.72 鹵7.39 days, respectively. The patients in the three groups were followed up for 15-60 months (mean 40.65 鹵14.40 months). With the exception of 3 patients with urinary incontinence, 2 patients in the NHT group had urinary incontinence and 1 patient in the RP group, the average recovery time of urinary control was 55.67 鹵13.72 days and 60.84 鹵15.17 dP0. 01 in the NHT group respectively. Urethral stricture occurred in 2 cases, incision infection in 1 case, fat liquefaction in 2 cases, urinary incontinence in 2 cases, urinary incontinence in 2 cases, urinary incontinence in 2 cases and urethral stricture in 2 cases. In the RP group, there were 1 case of urethral stricture, 1 case of urinary incontinence, 1 case of lymphatic leakage, 1 case of incision infection, 2 cases of rectal injury, and 2 cases of rectal injury. The non-biochemistry recurrence rates for 2 years and 5 years in the RP and MAB group were 96.37.04 and 89.68.43, respectively. The non-local recurrence rates of NHT and RP were 96.30% and 86.85% (2 years P0. 364, 5 years P0. 025), respectively. The specific survival rates of the three groups were 100, 98.1586.84% and 84.10% respectively, and the overall survival rates of 5 years were 94.4484.21% and 81.82% P0.099%, respectively, and the survival rates of 5 years were 98.1586.84% and 84.10% P0.0280.The overall survival rates of 5 years were 94.444.21% and 81.822P 0.099%, respectively. The specific survival rates of the three groups were 100, and the 5-year disease specific survival rates were 98.1586.84% and 84.10% P0.0280.The overall survival rates for 5 years were 94.4484.21% and 81.822% respectively. Conclusion. Radical resection combined with preoperative neoadjuvant endocrine therapy for stage T3bN0M0 prostate cancer is safe and feasible, does not increase the risk of operation, and can appropriately reduce intraoperative blood loss. Neoadjuvant endocrine therapy can reduce prostate volume and PSA level. It can reduce the positive rate of tumor margin (especially for prostate cancer with Gleason score 鈮，

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