Clinical Efficacy of Immediate Radical Surgery for Locally Advanced Prostate Cancer
-
摘要:
目的 探讨局部晚期前列腺癌确诊后即刻行腹腔镜前列腺癌根治术的临床疗效及安全性。 方法 回顾性分析2018年1月至2023年1月在云南省曲靖市第一人民医院确诊的63例符合纳入标准的局部晚期前列腺癌患者，所有患者均为超声引导下经会阴前列腺穿刺活检确诊，其中实验组37例，病理确诊后即刻接受腹腔镜前列腺癌根治术，术后辅助内分泌治疗；对照组26例，先接受3个月新辅助内分泌治疗，再行根治术，术后给予辅助内分泌治疗。观察两组患者在手术时间、术中出血量、住院时间、留置尿管时间、切缘阳性率、直肠损伤、淋巴结阳性率、尿瘘和淋巴漏发生率、PSA水平变化、术后尿控、生化复发及远处转移方面的差异。 结果 对照组接受新辅助内分泌治疗后，血清PSA、前列腺体积、临床分期明显降低；实验组切缘阳性率相比对照组显著升高，差异有统计学意义（P < 0.05）；两组患者手术时间、术中出血量、住院时间、留置尿管时间、直肠损伤、淋巴结阳性率、尿瘘和淋巴漏发生率之间的差异无统计学意义（P > 0.05）；随访18～36个月，两组患者术后1个月血清PSA水平、术后6个月完全尿控率、术后1年、2年生化复发及远处转移间的差异无统计学意义（P > 0.05）。 结论 局部晚期前列腺癌确诊后即刻行腹腔镜前列腺癌根治术是临床安全可行的治疗方案。新辅助内分泌治疗使局部晚期前列腺癌肿瘤分期降级、切缘阳性率降低，前列腺体积明显缩小，获得更大操作空间，不增加手术风险。 -
关键词:
- 前列腺癌 /
- 新辅助内分泌治疗 /
- 局部晚期前列腺癌 /
- 腹腔镜下前列腺癌根治术
Abstract:Objective To explore the clinical efficacy and safety of immediate laparoscopic radical prostatectomy immediately following the diagnosis of locally advanced prostate cancer. Methods A retrospective analysis was performed for 63 patients with locally advanced prostate cancer who met the inclusion criteria diagnosed in The 1st People's Hospital of Qujing City, Yunnan Province from January 2018 to January 2023. All patients were diagnosed via ultrasound-guided transperineal prostate biopsy. The experimental group consisted of 37 patients who underwent immediate laparoscopic radical prostatectomy after pathological diagnosis, followed by postoperative adjuvant hormone therapy. The control group included 26 patients who first received 3 months of neoadjuvant hormone therapy before undergoing radical surgery, followed by adjuvant hormone therapy postoperatively. The two groups were compared in terms of surgical duration, intraoperative blood loss, length of hospital stay, duration of catheterization, positive surgical margin rate, rectal injury, positive lymph node rate, incidence of urinary fistula and lymphatic leakage, changes in PSA level, postoperative urinary control, biochemical recurrence and distant metastasis. Results In the control group, serum PSA levels, prostate volume, and clinical staging significantly decreased after neoadjuvant hormon therapy. The positive surgical margin rate in the experimental group was significantly higher than that in the control group, with a statistically significant difference（P < 0.05）. There were no statistically significant differences between the two groups in terms of surgical duration, intraoperative blood loss, length of hospital stay, duration of catheterization, rectal injury, positive lymph node rate, incidence of urinary fistula and lymphatic leakage （P > 0.05）. Follow-up at 18 to 36 months revealed no statistically significant differences between the two groups in terms of serum PSA levels at one month post-surgery, complete urinary control rate at six months post-surgery, and biochemical recurrence and distant metastasis at one and two years post-surgery （P > 0.05）. Conclusion Immediate laparoscopic radical prostatectomy following the diagnosis of locally advanced prostate cancer is a clinically safe and feasible treatment option. Noadjuvant hormone therapy reduces tumor staging, lowers the positive surgical margin rate, significantly decreases prostate volume, and provides greater operational space without increasing surgical risks. -
表 1 实验组与对照组患者临床资料[n（%）/$ \bar x \pm s $/ M（P25，P75）]
Table 1. Clinical data of patients in the experimental group and the control group[n（%）/$ \bar x \pm s $/ M（P25，P75）]
资料 对照组（n = 26） 实验组（n = 37） t/Z P 年龄（岁） 67.58 ± 3.29 67.22 ± 4.17 0.368 0.714 BMI（kg/m2） 22.79 ± 2.68 23.84 ± 2.72 −1.512 0.136 初诊血清PSA（ng/mL） 24.39（18.31，34.83） 19.57（15.60，29.49） −1.445 0.148 初诊前列腺体积（mL） 48.01 ± 8.84 46.49 ± 8.30 0.695 za0.489 术前Gleason评分 −0.287 0.774 6 3（11.53） 3（8.11） 7 14（53.85） 24（64.86） 8 7（26.92） 7（18.92） 9 2（7.69） 3（8.11） 10 0（0.00） 0（0.00） 临床TNM分期 −0.076 0.939 T3aN0M0 13（50.00） 18（48.65） T3aN1M0 1（3.85） 2（5.41） T3bN0M0 8（30.77） 13（35.12） T3bN1M0 3（11.54） 2（5.41） T4N0M0 1（3.85） 2（5.41） 
下载: 导出CSV
表 2 对照组NHT治疗前后数据对比[n（%）/$ \bar x \pm s $/ M（P25，P75）]
Table 2. Comparison of data before and after NHT treatment in the control group[n（%）/$ \bar x \pm s $/ M（P25，P75）]
资料 NHT治疗前 NHT治疗后 Z/t P 前列腺体积（mL） 48.01 ± 8.84 40.33 ± 8.22 3.244 0.002* 血清PSA（ng/mL） 24.39（18.31，34.83） 0.445（0.085，0.820） −4.457 0.000* Gleason评分 6 3（11.53） 4（15.38） 7 14（53.85） 14（53.85） 8 7（26.92） 6（23.08） 9 2（7.69） 2（7.69） 10 0（0.00） 0（0.00） 临床TNM分期 T2cN0M0 0（0.00） 2（7.69） T3aN0M0 13（50.00） 14（53.85） T3aN1M0 1（3.85） 0（0.00） T3bN0M0 8（30.77） 8（30.77） T3bN1M0 3（11.54） 2（7.69） T4N0M0 1（3.85） 0（0.00） *P < 0.05。
下载: 导出CSV
表 3 围手术期情况对比[n（%）/ M（P25，P75）]
Table 3. Comparison of perioperative conditions[n（%）/ M（P25，P75）]
观察指标 对照组（n = 26） 实验组（n = 37） Z/χ2 P 手术时间（h） 3.2（2.3，4.0） 3.1（3.0，3.3） −0.035 0.972 术中出血量（mL） 175（100，225） 100（100，250） −0.146 0.884 住院时间（d） 10.5（8.0，12.0） 10.0（7.5，11.0） −0.928 0.353 留置尿管时间（d） 14.0（14.0，15.0） 14.0（13.0，14.5） −0.980 0.327 直肠损伤 1（3.80） 0（0.00） 1.446 0.413 切缘阳性 2（7.70） 11（29.70） 4.528 0.033* 淋巴结阳性 2（7.70） 5（13.50） 0.100 0.751 尿瘘 1（3.80） 1（2.70） 0.65 0.799 淋巴瘘 1（3.80） 2（5.40） 0.82 0.775 *P < 0.05。
下载: 导出CSV
表 4 术后随访情况对比[n（%）/ M（P25，P75）]
Table 4. Comparison of postoperative follow-up[n（%）/ M（P25，P75）]
观察指标 对照组（n = 26） 实验组（n = 37） Z/χ2 P 术后1个月 血清PSA（ng/mL） 0.012（0.006，0.068） 0.021（0.006，0.0625） −0.395 0.693 术后6个月 完全尿控率 20（76.90） 26（70.30） 0.343 0.558 生化复发 1年 2（7.70） 3（8.10） 0.004 0.952 2年 3（11.50） 6（16.20） 0.273 0.601 远处转移 2（7.70） 4（10.80） 1.72 0.678
下载: 导出CSV
-
[1] Abudoubari S,Bu K,Mei Y,et al. Prostate cancer epidemiology and prognostic factors in the United States[J]. Front Oncol,2023,13:1142976. doi: 10.3389/fonc.2023.1142976 [2] Sung H,Ferlay J,Siegel R L,et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. Ca-Cancer J Clin,2021,71(3):209-249. doi: 10.3322/caac.21660 [3] Kensler K H,Rebbeck T R. Cancer progress and priorities: Prostate cancer[J]. Cancer Epidem Biomar,2020,29(2):267-277. doi: 10.1158/1055-9965.EPI-19-0412 [4] Trabzonlu L,Kulac I,Zheng Q,et al. Molecular pathology of high-grade prostatic intraepithelial neoplasia: Challenges and opportunities[J]. Cold Spring Harb Perspect Med,2019,9(4):a030403. doi: 10.1101/cshperspect.a030403 [5] 林豪胜,杨增士,叶宁. 基于年龄-时期-队列模型的中国前列腺癌发病死亡趋势分析[J]. 临床泌尿外科杂志,2024,39(8):708-712. [6] Vale C L,Fisher D,Kneebone A,et al. Adjuvant or early salvage radiotherapy for the treatment of localised and locally advanced prostate cancer: A prospectively planned systematic review and meta-analysis of aggregate data[J]. Lancet,2020,396(10260):1422-1431. doi: 10.1016/S0140-6736(20)31952-8 [7] Ke Z,Xu Y,Shu Y,et al. Multivariate logistic regression analysis of the clinical factors influencing locally advanced prostate cancer[J]. Transl Cancer Res,2024,13(2):676-685. doi: 10.21037/tcr-23-1680 [8] Zhang L,Zhao H,Wu B,et al. The impact of neoadjuvant hormone therapy on surgical and oncological outcomes for patients with prostate cancer before radical prostatectomy: A systematic review and meta-analysis[J]. Front Oncol,2020,10:615801. [9] Montie J E. Initial therapy with radical prostatectomy for high risk localized prostate cancer[J]. Journal of Urolgy,2006,176 (6 Pt 2): S27-S26. [10] 冯春丽,周建于,段文越,等. 新辅助内分泌治疗对前列腺癌根治术疗效的影响研究[J]. 石河子科技,2021,4(1):54-57. [11] 那彦群,叶章群,孙颖浩,等. 2014版中国泌尿外科疾病诊断治疗指南手册[M]. 北京: 人民卫生出版社,2013,125-127. [12] Wang Z,Ni Y,Chen J,et al. The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: A systematic review and meta-analysis[J]. World Journal of Surgical Oncology,2020,18(1):42. doi: 10.1186/s12957-020-01824-9 [13] Shelley M D,Kumar S,Wilt T,et al. A systematic review and meta-analysis of randomised trials of neo-adjuvant hormone therapy for localised and locally advanced prostate carcinoma[J]. Cancer Treatment Reviews,2009,35(1):9-17. doi: 10.1016/j.ctrv.2008.08.002 [14] Joung J Y,Kim J E,Kim S H,et al. The prevalence and outcomes of pT0 disease after neoadjuvant hormonal therapy and radical prostatectomy in high-risk prostate cancer[J]. BMC Urology,2015,13(15):82. [15] Naiki T,Kawai N,Okamura T,et al. Neoadjuvant hormonal therapy is a feasible option in laparoscopic radical prostatectomy[J]. BMC Urology,2012,12:36. doi: 10.1186/1471-2490-12-36 [16] 伍宏亮,汪盛,关翰. 新辅助内分泌治疗联合腹腔镜前列腺癌根治术对局部晚期前列腺癌的疗效分析[J]. 蚌埠医学院学报,2019,44(6):768-770. [17] 胡凯强. 新辅助内分泌治疗联合腹腔镜前列腺癌根治术在高危前列腺癌治疗中临床研究[D]. 石家庄: 河北医科大学,2021. [18] 李清,肖博,刘士军,等. 前列腺穿刺活检术后间隔时间对腹腔镜前列腺癌根治术的影响[J]. 北京大学学报(医学版),2014,46(4):532-536. doi: 10.3969/j.issn.1671-167X.2014.04.009 [19] 祝秀文,万里军,童炎岳,等. 前列腺穿刺活检术后间隔时间对腹腔镜前列腺癌根治术的影响[C]// 浙江省医学会泌尿外科学分会,浙江省医学会男科学分会. 2019年浙江省医学会泌尿外科学、男科学学术大会论文汇编. 衢州市人民医院;2019: 2. [20] 蒋齐,杨刚,江斌,等. 不同径路前列腺穿刺活检对于前列腺癌根治手术过程影响的临床研究[J]. 临床泌尿外科杂志,2022,37(6):418-421. [21] Reisz P A,Laviana A A,Zhao Z,et al. Assessing the quality of surgical care for clinically localized prostate cancer: Results from the ceasar study[J]. Journal of Urology,2020,204(6):1236-1241. doi: 10.1097/JU.0000000000001198 [22] Kim M,Yoo D,Pyo J,Cho W. Clinicopathological significances of positive surgical resection margin after radical prostatectomy for prostatic cancers: A meta-analysis[J]. Medicina Lithuania,2022,58(9):1251. [23] Cho S Y,Choi Y D. The effect of tumor-prostate ratio on biochemical recurrence after radical prostatectomy[J]. World Journal of Mens Health,2016,34(2):123-128. doi: 10.5534/wjmh.2016.34.2.123 [24] Sun G,Liang Z,Jiang Y,et al. Clinical analysis of perioperative outcomes on neoadjuvant hormone therapy before laparoscopic and robot-assisted surgery for localized high-risk prostate cancer in a Chinese cohort[J]. Current Oncology,2022,29(11):8668-8676. doi: 10.3390/curroncol29110683 [25] Hu J C,Hung S C,Ou Y C. Assessments of neoadjuvant hormone therapy followed by robotic-assisted radical prostatectomy for intermediate and high-risk prostate cancer[J]. Anticancer Research,2017,37(6):3143-3150. [26] 张浩永,许方蕾. 前列腺癌患者根治术后尿失禁危险因素的meta分析[J]. 临床泌尿外科杂志,2024,39(8):713-718+724. [27] Kawase M,Goto T,Ebara S,et al. Nomogram predicting locally advanced prostate cancer in patients with clinically organ-confined disease who underwent robot-assisted radical prostatectomy: A retrospective multicenter cohort study in Japan (the MSUG94 group)[J]. Ann Surg Oncol,2023,30(11):6925-6933. doi: 10.1245/s10434-023-13747-2 [28] Hsu C Y,Wildhagen M F,Van Poppel H,et al. Prognostic factors for and outcome of locally advanced prostate cancer after radical prostatectomy[J]. Bju Int,2009,105(11):1536-1540. [29] Tosco L,Laenen A,Briganti A,et al. The survival impact of neoadjuvant hormonal therapy before radical prostatectomy for treatment of high-risk prostate cancer[J]. Prostate Cancer and Prostatic Diseases,2017,20(4):407-412. doi: 10.1038/pcan.2017.29 [30] Berglund R K,Tangen C M,Powell I J,et al. Ten-year follow-up of neoadjuvant therapy with goserelin acetate and flutamide before radical prostatectomy for clinical T3 and T4 prostate cancer: Update on southwest oncology group study 9109[J]. Urology,2012,79(3):633-637. doi: 10.1016/j.urology.2011.11.019 [31] Roldan F L,Falagario U G,Olsson M,et al. Long-term oncological outcomes after multimodal treatment for locally advanced prostate cancer[J]. Bjui Compass,2024,5(9):885-892. -
