根治性外放射治疗与根治性前列腺切除术治疗局限性高危前列腺癌的疗效比较

目的 比较根治性外放射治疗（ExRT）与根治性前列腺切除术（RP）治疗局限性高危前列腺癌患者的疗效。方法 回顾性分析诊断为高危前列腺癌（T2b-T4N0M0）并接受ExRT或RP的150例患者。高危前列腺癌的入选标准为PSA≥20 ng/ml或cT3以上或GS≥8。主要研究终点为无生化复发生存期，次要研究终点为无远处转移生存期、癌症特异性生存期及总生存期。结果 88例患者接受了ExRT及雄激素剥夺治疗（ADT），其余62例患者接受了RP及盆腔淋巴结清扫术（PLND）。两组患者的中位年龄（68.9±5.2 vs. 64.3±6.5岁, P=0.012）及中位随访时间（60.2±32.3 vs. 45.8±25.5月，P=0.005）差异有统计学意义。ExRT组患者生化复发率显著低于RP组患者（23.9% vs. 58.1%, P<0.001），而无生化复发患者生存期显著延长（96.2±7.4 vs. 38.7±4.6月, P<0.001）。两组无远处转移生存期、癌症特异性生存期及总生存期差异均无统计学意义。结论 与RP相比，接受ExRT治疗的局限性高危前列腺癌患者生化复发率低，无生化复发生存期显著延长。

Efficacy of Definitive External-beam Radiotherapy Versus Radical Prostatectomy on Clinically Localized High-risk Prostate Cancer Patients: A Retrospective Study

Objective To retrospectively compare the efficacy between definitive external-beam radiotherapy (ExRT) and radical prostatectomy(RP) on patients with localized high-risk prostate cancer (PCa). Methods We retrospectively studied 150 patients with high-risk PCa(T2b-T4N0M0) who underwent definitive ExRT or RP. The inclusion criteria for high-risk PCa were PSA≥20 ng/ml or above cT3 or GS≥8. The primary end point was biochemical failure free survival(BFFS), and the secondary end point was distant metastasis free survival(DMFS), cancer-specific survival(CSS) and overall survival(OS). Results A total of 88 patients underwent definitive ExRT and androgen deprivation therapy(ADT), and the remaining 62 patients underwent RP and pelvic lymphadenectomy(PLND). The median age and follow-up time were statistically significant between ExRT and RP groups(P<0.05). The biochemical failure(BF) rate in ExRT group was significantly lower than that in RP group(P<0.001), while BFFS was significantly increased(P<0.001). The DMFS, CSS and OS were not significantly different between the two groups. Conclusion BF rate after definitive ExRT in patients with localized high-risk PCa are significantly lower than those undergoing RP, while BFFS is significantly increased.