术前血清睾酮预测前列腺癌根治术后局部转移和生化复发的研究报告

目的:探讨术前血清总睾酮水平在接受前列腺癌根治术(RP)患者局部转移和术后生化复发之间的联系。方法:研究收集了2009年1月—2018年5月在九江学院附属医院及南昌大学第二附属医院接受RP患者108例,收集患者年龄、术前血清总睾酮、术前血清总前列腺特异性抗原(tPSA)、Gleason评分和病理分期等。局部转移前列腺癌定义为pT_(3～4)或N_1期,术后前列腺癌生化复发定义为连续2次测量tPSA0.2 ng/mL。研究调查临床和病理因素,如年龄、术前血清睾酮水平、tPSA和病理Gleason评分与局部转移和术后生化复发的关系。结果:局部转移前列腺癌患者的平均术前血清总睾酮显著低于非局部转移前列腺癌患者(407.66μg/dL vs.726.34μg/dL,P=0)。二分类Logistic回归分析显示,病理Gleason评分和术前血清总睾酮、血清tPSA是前列腺癌局部转移的重要预测因子。按血清睾酮25%百分数位置将患者分为高血清总睾酮和低血清总睾酮水平组,结果显示术前低血清总睾酮水平与术后复发有显著相关性(P=0.042)。结论:较低的术前血清总睾酮水平与局部转移前列腺癌分期和术后生化复发有密切相关。     

初始治疗采用根治性切除术或近距离放射治疗对高危前列腺癌患者预后的影响

目的 探讨初始治疗采用前列腺根治性切除术(RP)或近距离放射治疗(BT)对高危前列腺癌患者预后的影响,为临床治疗方案的选择提供参考。方法 提取SEER数据库2005—2014年133 191例接受RP或BT治疗的高危前列腺癌患者的临床资料。采用K-M分析以及单因素、多因素Cox回归分析比较患者5年和10年的肿瘤特异性生存率(CSS)和总生存率(OS)。同时收集苏北人民医院2015—2020年诊断为高危前列腺癌患者253例,其中接受RP者153例,接受BT者100例,采用K-M分析比较患者5年无生化复发生存期(bPFS)和5年CSS。结果 基于SEER数据库资料的单因素分析结果显示：BT与较高的死亡风险相关(HR=1.319,95%CI:1.256～1.386,P<0.001);年龄、婚姻状况和TNM分期也均与较高的死亡风险相关(P<0.001)。多因素分析调整相关变量后结果显示：与RP比较,BT并不会导致较高的死亡风险(HR=0.964,95%CI:0.924～0.996,P=0.808)。从OS生存曲线图发现,观测的生存时间越长,RP的OS越优于BT(P<0.001...     

迟发型生化复发的定义及其临床研究结果

研究背景:前列腺癌根治术(radical prostatectomy,RP)后生化复发(prostate-specificantigen recurrence,PSAR)的发生与RP术后时间有着怎样的关系目前尚未明了,我们将RP术后超过5年发生的PSAR定义为迟发型生化复发.     

循环肿瘤细胞水平与前列腺癌根治术后生化复发的相关性

目的 探讨前列腺癌根治术后循环肿瘤细胞(CTCs)水平与术后生化复发(BCR)的相关性。方法 选取2015年5月至2018年5月于郑州大学第二附属医院行前列腺癌根治手术的患者73例,根据术后是否发生BCR分为BCR组(19例)和非BCR组(54例)。记录并比较两组患者临床资料,利用CanPatrol TM二代CTC检测技术检测血清CTCs表达水平;利用多因素Logistic回归分析影响前列腺癌患者术后发生BCR的危险因素;利用受试者工作特征(ROC)曲线评价术前前列腺特异抗原(PSA)、CTCs水平对根治性前列腺癌切除术(RP)术后BCR的诊断价值。结果 研究组与对照组年龄、体质指数(BMI)差异无统计学意义(P0.05),术前PSA水平、Gleason评分、精囊侵犯阳性率、切缘阳性率、病理分期差异有统计学意义(P0.05);BCR组患者血清CTCs水平显著高于非BCR组患者(6.94±1.04 vs.5.03±1.21,P0.05);多因素Logistic回归分析结果显示,术前高PSA水平、高Gleason评分、病理分期加重、高CTCs水平是影响前列腺癌RP术后BCR发生的危险因素;ROC结果显示,术前PSA水平、CTCs水平预测前列腺癌RP术后BCR的曲线下面积(AUC)分别为0.716(95%CI:0.599～0.816)、0.877(95%CI:0.779～0.922),敏感性分别为68.42%、78.95%,特异性分别为79.63%、87.04%;二者联合的AUC为0.906(95%CI:0.815～0.962),敏感性和特异性分别为73.68%、92.59%。结论 CTCs水平在前列腺癌患者RP术后BCR患者血清中呈高表达,是影响BCR发生的危险因素,且对RP术后BCR具有一定的诊断价值。     

不同治疗方案与局部晚期前列腺癌患者前列腺特异性抗原进展及生存状况的Meta分析

目的 应用Meta分析探讨不同治疗方案对局部晚期前列腺癌前列腺特异性抗原(PSA)进展及生存状况的影响. 方法制订原始文献的纳入标准、剔除标准及检索策略.以优势比(OR)及其95%可信区间(95%CI)为效应尺度,应用Meta分析固定效应模型和随机效应模型对有关治疗局部晚期前列腺癌不同方案的纳入文献进行综合定量评价. 结果 符合纳入标准的8篇文献进入Meta分析,共3826例.5篇为前列腺根治性切除术(RP)联合辅助治疗与单纯用RP或不用RP进行比较,以PSA进展率为评价指标,合并后的OR值为0.86,95%CI为0.48～1.56;3篇为RP联合激素治疗与单纯用RP或不用RP进行比较,以疾病特异性死亡率为评价指标,合并后的OR值为0.72,95%CJ为0.51～1.02. 结论 RP联合辅助治疗可以显著减少局部晚期前列腺癌患者术后PSA进展,对疾病特异性死亡率却无显著影响.     

临床局限性前列腺癌根治性切除与观察等待预后比较的Meta分析

目的比较临床局限性前列腺癌行根治性切除(radical prostatectomy,RP)和观察等待(watchful waiting,WW)对患者生存的影响。方法通过计算机检索Medline、Cochrane Library、ISI web of knowledge、Sino Med文献检索平台,搜集国内外2014年7月前发表的关于早期前列腺癌根治性切除与主动监测的预后的随机、半随机对照试验或观察性研究,预后评价指标包括总体死亡、前列腺癌特异死亡;由2位研究者根据纳入与排除标准独立进行文献筛选、资料提取和质量评价后,采用Rev Man5.2进行统计分析。结果纳入3个随机对照试验和10个临床队列研究,其中RCT共1 537例、队列研究共186 590例患者;Meta分析结果显示两种治疗方法(RP/WW)的总体死亡(ACM)风险为HR=0.59[95%CI(0.51,0.69),P0.00001],前列腺癌特异死亡(CSM)风险HR=0.43[95%CI(0.32,0.58),P0.00001],且不论RCT组还是队列研究组,结果均一致倾向RP。结论早期前列腺癌根治性切除可减少总体死亡及前列腺癌特异死亡风险,对于早期局限性前列腺癌选择观察等待应当十分慎重。     

前列腺癌根治术后勃起功能障碍的康复治疗

勃起功能障碍(ED)是前列腺癌根治术(RP)后最常见的并发症之一,严重影响患者术后的生活质量[1].以往由于医患双方对癌症治疗的过度关注,RP术后的ED往往被忽视,特别在国内,大部分前列腺癌患者RP手术时的年龄已接近或达到70岁,术前即已存在不同程度的ED,或是已经没有正常的性生活.但随着近年来国内前列腺癌发病率快速上升和PSA筛查的广泛开展,早期前列腺癌以及年轻前列腺癌患者检出的比例有所升高.这些患者在关注癌症治疗的同时,也势必担心手术对其生活质量,特别是性生活带来的不利影响.因此,关注RP术后患者的ED,开展康复治疗有其积极意义.     

循环miR-152对前列腺癌生化复发早期预测的研究

目的:探讨循环微小RNA 152(miR-152)对前列腺癌生化复发早期预测的价值。方法:收集将要进行前列腺癌手术的患者66例(生化复发组:35例,术后2年内生化复发;未生化复发组:31例,术后2年内未生化复发),另择年龄相匹配的31例健康男性作为健康对照组。用qRT-PCR法检测前列腺癌患者和健康对照组的循环miR-152表达水平。应用ROC曲线分析循环miR-152对前列腺癌早期生化复发的诊断价值。分析复发组循环miR-152表达水平与临床病理参数(年龄、术前PSA水平、Gleason积分、临床分期、骨转移)之间的相关性。结果:循环miR-152在前列腺癌术后患者(未生化复发及生化复发)与健康对照组的表达差异有统计学意义(t=-5.212,P=0.001)。前列腺癌术后生化复发组患者循环miR-152的表达量较未生化复发组患者低,差异有统计学意义(t=-5.727,P=0.001)。循环miR-152对前列腺癌术后生化复发早期预测的ROC曲线下面积(AUC)为0.906(95%CI,0.809~0.964),灵敏度和特异度分别为91.4%、80.6%。循环miR-152表达水平与Gleason积分、临床分期、有无生化复发和骨转移相关(P均<0.05);随着Gleason积分、临床分期的增加,循环miR-152的表达水平下降。但miR-152表达量与患者年龄、术前PSA无关(P均>0.05)。结论:循环miR-152表达水平在前列腺癌术后生化复发患者中显著降低,可能成为前列腺癌生化复发早期预测的分子标志物。     

前列腺癌患者手术去势与药物去势的去势效果及相关不良反应比较的真实世界研究

目的:通过回顾性分析总结真实世界中手术去势与药物去势对前列腺癌患者的去势效果以及相关不良反应的影响，从而为前列腺癌患者内分泌治疗的选择提供现实指导。方法:收集2014年1月—2019年1月在川北医学院附属医院行手术去势(130例)和药物去势(114例)的前列腺癌患者资料，包括患者治疗前体重指数(body mass index, BMI)、空腹血糖(fasting blood glucose, FBG)、甘油三酯(triglyceride, TG)、血清总胆固醇(serum total cholesterol, TC)、尿酸(uric acid, UA)、高密度脂蛋白(high-density lipoprotein, HDL)、低密度脂蛋白(low-density lipoprotein, LDL)、前列腺特异性抗原(prostate specific antigen, PSA)、睾酮(testosterone, T)及Gleason评分等检验指标，并使用国际前列腺症状评分(IPSS)以及前列腺癌患者生活质量子量表(QLQ-PR25)进行相关评分，以手术日或第1次注射促黄体生成激素释放...     

前列腺癌治疗后勃起功能的预测

背景:性功能是前列腺癌治疗后患者的健康相关生活质量评分(HRQOL)最常受损的部分。然而,目前尚缺乏能够个体化预测前列腺癌治疗后患者勃起功能的检测手段。目的:根据每个前列腺癌患者的特点与治疗方案的不同来预测其长期勃起功能。方法:在一项多中心纵向队列研究(前列腺癌预后和治疗满意度质量评价;统计自2003～2006年)中,统计治疗前患者的特点、健康相关的性生     

Outcome of surgery for clinical unilateral T3a prostate cancer: a single-institution experience

OBJECTIVES: The optimal management of locally advanced prostate cancer (cT3) is still a matter of debate. The objective of this study is to present 10-year outcomes of radical prostatectomy (RP) in unilateral cT3a disease. PATIENTS AND METHODS: Between 1987 and 2004, 2273 patients underwent RP at our institution. Two hundred and thirty-five (10.3%) patients were assessed as unilateral cT3a disease by digital rectal examination. Thirty-five patients who received neoadjuvant treatment before surgery were excluded from further analysis. Mean follow-up was 70.6 months. Kaplan-Meier survival analysis was used to calculate the biochemical progression-free survival (BPFS), clinical progression-free survival (CPFS), cancer-specific survival (CSS), and overall survival (OS) rates. Cox uni- and multivariate regression analyses were used to identify predictive factors in BPFS and CPFS. RESULTS: Clinical overstaging (pT2) occurred in 23.5%. One hundred and twelve (56%) patients received adjuvant or salvage therapy. OS at 5 and 10 years was 95.9% and 77.0%, respectively, and CSS was 98.7% and 91.6%. BPFS at 5 and 10 years was 59.5% and 51.1%, respectively, and CPFS was 95.9% and 85.4%. Margin status was a significant independent predictor in BPFS; cancer volume was a significant independent predictor in CPFS. CONCLUSIONS: Clinically advanced prostate cancer is still frequently overstaged. In a well-selected patient group with locally advanced prostate cancer, RP--with adjuvant or salvage treatment when needed--can yield very high long-term cancer control and survival rates. Margin status and cancer volume are significant predictors of outcome after RP.     

术前血清胱抑素C水平对手术的肾癌患者预后的影响

目的探讨术前血清胱抑素C(Cystatin C,Cys-C)水平对肾癌患者预后的影响。方法回顾性分析2013年1月至2016年12月于徐州医科大学附属医院行根治性/部分肾切除术治疗的354例肾癌患者的临床病理和随访资料。根据受试者工作特征曲线(ROC)确定Cys-C的最佳临界值,将其分为高Cys-C组和低Cys-C组。运用Kaplan-Meier、Log-rank检验分析两组患者的总生存率和肿瘤特异性生存率的差异,通过单因素和多因素Cox模型分析影响患者总生存和肿瘤特异性生存的因素。结果共纳入354例患者,其中高Cys-C组36例、低Cys-C组318例。与低Cys-C组相比,高Cys-C组患者年龄更大、肿瘤分期更晚及尿素、肌酐、尿酸水平更高(P均<0.05),但肾小球滤过率相对较低(P<0.05)。Kaplan-Meier结果显示高Cys-C组与低Cys-C组5年总生存率分别为56.7%和96.2%,5年肿瘤特异性生存率分别为64.0%和96.5%(P均<0.05)。Cox多因素分析结果显示术前高Cys-C水平为肾癌患者术后总生存(HR:10.513,95%CI:2.539~43.522,P=0.001)和肿瘤特异性生存(HR:4.944,95%CI:1.017~24.043,P=0.048)的独立影响因素。结论肾癌患者术前血清Cys-C水平升高提示术后预后不良。     

Combination of adjuvant hormonal and radiation therapy significantly prolongs survival of patients with pT2-4 pN+ prostate cancer: results of a matched analysis

Background

Previous prospective randomised trials have shown a positive impact of adjuvant radiation therapy (RT) in patients with locally advanced prostate cancer. However, none of these trials included patients with lymph node invasion (LNI).

Objective

The aim of this study was to assess the impact of combination adjuvant hormonal therapy (HT) and RT on the survival of patients with prostate cancer and histologically documented lymph node metastases (pN+).

Design, setting, and participants

Data on 703 consecutive patients with LNI treated with radical prostatectomy, pelvic lymph node dissection, and adjuvant treatments between September 1986 and November 2002 at two large academic institutions were reviewed.

Measurements

For study purposes, patients treated with adjuvant HT plus RT and patients treated with adjuvant HT alone were matched for age at surgery, pathologic T stage and Gleason score, number of nodes removed, surgical margin status, and length of follow-up. Differences in cancer-specific survival (CSS) and overall survival (OS) were compared using the Kaplan-Meier method and life table analyses.

Results and limitations

Following the matching process, 117 pT2–4 pN1 patients of 171 (68.4%) treated with adjuvant HT plus RT (group 1) were compared with 247 pT2–4 pN1 patients of 532 (46.4%) receiving adjuvant HT alone (group 2). After matching, the two groups of patients were comparable in terms of pre- and postoperative characteristics (all p ≥ 0.07). Mean follow-up was 100.8 mo (median: 95.1 mo; range: 3.5–229.3 mo). Overall, prostate CSS and OS rates at 5, 8, and 10 yr were 90%, 82%, and 75%, and 85%, 70%, and 60%, respectively. Patients treated with adjuvant RT plus HT had significantly higher CSS and OS rates compared with patients treated with HT alone at 5, 8, and 10 yr after surgery (95%, 91%, and 86% vs 88%, 78%, and 70%, and 90%, 84%, and 74% vs 82%, 65%, and 55%, respectively; p = 0.004 and p < 0.001, respectively). Similarly, higher survival rates associated with the combination of HT plus RT were found when patients were stratified according to the extent of nodal invasion (namely, two or fewer vs more than two positive nodes; all p ≤ 0.006). Lack of standardised HT and RT protocols represents the main limitations of our retrospective study.

Conclusions

Adjuvant RT plus HT significantly improved CSS and OS of pT2–4 pN1 patients, regardless of the extent of nodal invasion. These results reinforce the need for a multimodal approach in the treatment of node-positive prostate cancer.     

术前纤维蛋白原和中性粒细胞淋巴细胞比值评估胃癌切除术患者预后的临床研究

目的:探讨术前纤维蛋白原(FBG)和中性粒细胞淋巴细胞比值(NLR)联合检测评估胃癌切除术患者预后的临床价值。方法:回顾性分析2010年1月至2014年10月在盘锦辽油宝石花医院普通外科行胃癌切除术并具有完整随访资料的195例患者的临床资料。依据中性粒细胞淋巴细胞比值和术前纤维蛋白原水平进行赋值分组,FBG正常为0分,FBG升高为1分,低NLR为0分,高NLR为1分,分为A组(F-NLR=0分)、B组(F-NLR=1分),C组(F-NLR=2分)。采用卡方检验比较各组临床病理特征,Log-rank方法比较各组患者术后5年总生存率,采用Cox回归模型进行单因素和多因素预后分析。结果:术前NLR与T分期(P=0.011)、N分期(P=0.018)、TNM分期(P=0.009)、术前CEA水平(P=0.013)和FBG水平(P=0.018)相关。高NLR组5年生存率为56.1%,低NLR组为74.4%,差异有统计学意义(P=0.013);高FBG组5年生存率为55.3%,FBG正常组为73.4%,差异有统计学意义(P=0.016);F-NLR分值越高,T分期(P=0.019)、N分期(P=0.030)、TNM分期(P=0.002)和术前CEA水平(P=0.014)等越高。F-NLR分值为0、1、2的患者5年生存率分别为80.8%、61.4%和38.5%(P<0.001)。Cox多因素分析显示,术前FBG和NLR均升高是根治性胃癌切除术患者预后不佳的独立危险因素。结论:FBG和NLR联合检测可以评估胃癌切除术预后,较单独应用FBG和NLR具有更大的临床价值。     

The role of lymphadenectomy in high risk prostate cancer

Historically, patients with high risk prostate cancer were considered poor candidates for radical prostatectomy (RP) due to the likelihood of positive pelvic lymph nodes and decreased long term survival. Although there is still no consensus on the optimal therapy for this group of patients, there is increasing evidence that surgery could play a role. Cancer specific survival (CSS) rates after RP for locally advanced disease at 10 year follow up range from 29 to 72%, depending on tumor differentiation. The role of pelvic lymph node dissection (PLND) in prostate cancer remains a controversial topic. Nonetheless, in conjunction with RRP extended PLND (ePLND) should be performed as extended lymph node dissection in lieu of standard PLND may increase staging accuracy, influence decision making with respect to adjuvant therapy and possibly impact outcome. High risk patients with organ confined prostate cancer and low volume (micro)metastatic disease may be the ones to profit most from this approach.     

Pretreatment total testosterone level predicts pathological stage in patients with localized prostate cancer treated with radical prostatectomy

PURPOSE: In the last decade numerous groups have shown that low levels of pretreatment serum total testosterone consistently predict more aggressive disease, worse prognosis and worse treatment response in patients with metastatic prostate cancer. Prior studies have not demonstrated this same correlation in patients with known localized disease. We rigorously tested pretreatment total testosterone levels as a potential staging and prognostic marker in a large cohort of 879 patients with localized cancer treated with radical prostatectomy. MATERIALS AND METHODS: We retrospectively reviewed the clinical records of 879 patients treated with radical prostatectomy between January 1, 1986 and June 30, 2002 from 9 hospital sites. Nonparametric tests were used to compare the relationship of pretreatment testosterone to other variables. Multivariate logistic regression analysis was used to assess clinical predictors of extraprostatic disease. Kaplan-Meier survival methods and Cox regression analysis were used to assess predictors of biochemical recurrence. RESULTS: Patients with non-organ confined prostate cancer (pT3-T4) showed significantly lower pretreatment total testosterone levels than those with organ confined cancer (pT1-T2) (nonparametric p = 0.041). In multivariate analysis pretreatment total testosterone emerged as a significant independent predictor of extraprostatic disease (p = 0.046). Total testosterone was not a significant predictor of biochemical (prostate specific antigen) recurrence (p = 0.467). CONCLUSIONS: Pretreatment total testosterone was an independent predictor of extraprostatic disease in patients with localized prostate cancer. As testosterone decreases patients have an increased likelihood of non-organ confined disease. Low testosterone was not predictive of biochemical recurrence, although trends observed dictate study in larger cohorts with mature followup.     

术前外周血血小板/淋巴细胞比值与前列腺癌患者临床病理特征及根治术后生存时间的相关性分析

目的 研究术前外周血血小板/淋巴细胞（PLR）比值与前列腺癌患者临床病理特征及根治术后生存时间的相关性,旨在为更好地治疗前列腺癌患者提供有效的理论依据。方法 回顾性分析2007年6月至2012年6月期间在本院行根治性手术切除并经病理诊断明确的164例前列腺癌患者的临床资料,并将其设为观察组,同时选取164例健康居民作为对照组。利用受试者工作特征（ROC）曲线,最终确定PLR的截点值为130,分为高PLR组（PLR≥130）和低PLR组（PLR<130）,分析术前PLR比值与前列腺癌患者临床病理特征以及术后生存时间的相关性,并采用Cox回归分析影响前列腺癌患者预后的独立危险因素。结果 术前PLR值与患者年龄、组织类型无明显相关（P>0.05）,与Gleason评分、临床分期、淋巴结转移、远处转移、分化程度、浸润深度存在明显的相关性（P<0.05）;术前PLR<130患者在1、3、5年中的无病生存期与总生存期明显高于术前PLR≥130患者（P<0.05）;经单因素分析,Gleason评分、临床分期、淋巴结转移、分化程度、术前PLR值、术后辅助治疗是影响前列腺癌患者预后的因素（P<0.05）,而年龄、远处转移、组织类型、浸润深度与前列腺癌患者预后无相关性（P>0.05）;经Cox回归分析显示：Gleason评分、临床分期、术前PLR≥130是影响前列腺癌患者预后的独立危险因素,而术后辅助治疗是提高患者预后生存率的保护因素;PLR联合PSA对前列腺癌患者诊断的灵敏度、特异度、阳性预测值以及阴性预测值明显高于PSA（P<0.05）。结论 术前PLR比值是影响前列腺癌患者预后的独立危险因素,可作为评价前列腺癌患者预后的指标之一,并且PLR联合PSA能提高对前列腺癌的诊断率,两种指标存在一定程度上存在一定的互补性。     

Diferencias en la supervivencia global y supervivencia cáncer específica en pacientes con cáncer de próstata de alto riesgo según el tratamiento primario aplicado

Introduction and objectives

There is no high-level evidence as to which primary treatment provides an overall survival (OS) or cancer-specific survival (CSS) advantage in high-risk localised prostate cancer (HRLPC).Our aim was to analyse the differences in survival and predictive factors in this group of patients, according to their primary treatment (radical prostatectomy (RP) or radiotherapy and androgen blockade (RT + HT)).