新辅助内分泌治疗对临床局限性前列腺癌手术病理和生化复发的影响

目的 了解新辅助内分泌治疗(NHT)对临床局限性前列腺癌手术病理和生化复发的影响.方法 经直肠前列腺穿刺活检确诊的52例临床局限性前列腺癌患者,分为联合治疗组(NHT之后行手术治疗,26例)和单纯手术组(26例),均由同一医师行开放性经耻骨后根治性前列腺切除术.统计2组手术时间、出血量、术后住院时间、PSA水平、穿刺组织和手术标本的Gleason评分、临床分期和病理分期及无生化复发生存率.用独立样本t检验比较2组手术时间、出血量、术后住院时间及PSA水平.用秩和检验比较2组穿刺和术后病理的Gleason评分、临床分期和病理分期.用配对t检验比较联合治疗组NHT治疗前后PSA水平的变化.用配对秩和检验比较穿刺组织和手术标本分期和Gleason评分的变化.用Fisher精确概率法比较2组Gleason评分和分期变化的比例.用Kaplan-Meier法分析术后无生化复发生存率.结果 联合治疗组和单纯手术组平均手术时间分别为184.3、183.2 min,平均出血量分别为1275.0、1411.5 ml,平均术后住院时间分别为10.1、13.2 d,2组比较差异均无统计学意义(P＞0.05).就诊时的平均PSA水平分别为28.11、18.40ng/ml(P＞0.05),联合治疗组患者经平均6.58个月NHT治疗后.平均PSA水平降至0.53 ng/ml(P＜0.01).联合治疗组穿刺组织和手术标本平均Gleason评分分别为7.46和7.62(P＞0.05),单纯手术组分别为6.46和7.31(P＜0.01).联合治疗组穿刺Gleason评分高于单纯手术组(P＜0.05),而2组手术标本Glesaon评分比较差异无统计学意义(P＞0.05).联合治疗组临床分期为T2 12例(46%)、T3 14例(54%),单纯手术组T1 1例(4%)、T2 21例(81%)、T3 4例(15%),2组比较差异有统计学意义(P＜0.01).联合治疗组病理分期T2 19例(73%),T3 7例(27%),单纯手术组T2 19例(73%)、T3 7例(27%),2组比较差异无统计学意义(P＞0.05).联合治疗组病理分期低于临床分期(P＜0.01),单纯手术组的病理分期和临床分期差异无统计学意义(P＞0.05).随访2～81个月,2组分别平均随访时间29.4、31.4个月.2组的1年无生化复发率分别为71%(10/14)和80%(16/20,P＞0.05),2年无生化复发率为56%(5/9)和60%(9/15,P＞0.05).结论 NHT治疗不会增加临床局限性前列腺癌患者的手术风险.对患者术后病理分期与Gleason评分有一定改善,对术后无生化复发生存率可能有积极影响.

Effect of neoadjuvant hormone therapy on pathological parameters and PSA relapse-free survival of localized prostate cancer patients

Objective To evaluate the effect of neoadj uvant hormone therapy(N HT)before radical prostatectomy on pathological parameters and PSA relapse-free survival of localized prostate cancer patients. Methods A prospective nonrandomized case-control study including 52 localized prostate cancer patients was carried OUt.Of these cases,26 received NHT first(combined androgen blockade for at least 6 months)and then the open retropubic radical Drostatectomy(ORRP).and the other 26 underwent ORRP directly(Non-N HT).The data were analyzed by suing software SPSS 10.0,comparing PSA level before treatment,operation time,estimated blood 10ss and the hospital stay al ter operaUon with independent-samples t test,comparing Gleason scores of biopsy tissues and pathological examination,clinical and pathological stage with rank test.The changes of PSA levels were compared with paired'samples t test,Gleason scores of biopsy and surgical tissues.clinical and pathological stage were compared with paired-samples rank test,the proportion of patients whose GI- eason scores and stage had changed were compared with Fishe(s precise probabilistic method.the PSA relapse-free survival was compared with Kaplan-Meier. Results There were no significant differ ences between these 2 groups with respect to the operation time(184.3 min vs 183.2 min,P>0.05), the estimated blood loss(1275.0 ml vs 1411.5 ml,P>0.05)and the hospital stay after operation (10.1 d vs 13.2 d,P>0.05).There was no significant difference between pre-treatment PSA levels of NHq、patients and Non-NHT patients(28.11 ng／ml vs 18.40 ng／ml,P>0.05).In NHT group. the mean serum PSA leveof patients was 0.53 ng／ml after NHT(mean 6.58 months).The mean GI- eflson scores of biopsy and surgical tissue was 7.46 and 7.62 in NHT group(P>0.05),and was 6.46 and 7.31 in Non-NHT group(P<0.01),respectively.Biopsy tissue Gleason score in NHT group was higher than that in Non-NHT group.No difference of surgical tissue Gleason scores wfls seen between NHT and Non-NHT groups.The clinical stage was:16 cases of T2(46％)and 14 cases of T3(54％) in NHT group and 1 ease of T1(4％),21 cases of T2(81％)and 4 cases of T3(15％)in Non-NHT group(P<0.01).The pathological stage was:1 9 cases of T2(73％)and 7 cases of T3(27％)in NHT group,and the same in Non-NHT group(P>0.05).The follow-up time was 2-81 months.The mean follow-up time of NHT and Non-NHT groups was 29.4 and 31.4 months(P>0.05).The PSA relapse-free survival rates of NHT and Non-NHT groups were 71％(10／14)and 81％(16／20,P> 0.05)in 1'year,and were 56％(5／9)and 60％(9／15,P>0.05)in 2 years. Conclusions NHq'will not increase operation risk.It will improve both the pathological stage and Gleason scores and maybe affect the PSA relapse-free survival in patients with localized prostate cancer.