早期前列腺癌不同治疗模式的疗效及生化复发的危险因素分析

目的 探讨早期（T1~2N0M0）前列腺癌患者根治性手术或根治性放疗疗效对比及影响生化复发的相关因素。方法 回顾性分析新疆医科大学附属第一临床学院2004年4月至2012年4月间收治的269例早期前列腺癌根治术后患者的临床资料，采用多因素Logistic回归模型分析前列腺癌生化复发的危险因素。结果 269例前列腺癌患者中有97例经随访检测发生前列腺特异性抗原PSA（prostatespecific antigen）升高。单因素分析显示，肿瘤分期、Gleason评分、治疗前PSA水平、治疗前血红蛋白（hemoglobin，HGB）、肥胖与前列腺癌生化复发有关（P均＜0.05）；多因素分析显示，肿瘤分期、Gleason评分、治疗前PSA水平、肥胖是前列腺癌患者生化复发的独立高危因素（P均＜0.05）。两种不同的根治性治疗方式的生化复发率比较，总体累积生化复发率为36.0%，其中根治术组累积生化复发率为36.5%（23/63），根治放疗组为36.0%（74/206），两组生化复发的趋势较为一致。两种根治性治疗方式，治疗后第2年及第5年生化复发机率会增高。结论 T分期≥T2a、Gleason评分≥7 分、治疗前PSA≥10 ng/ml、肥胖的前列腺癌患者治疗后生化复发风险较高。对早期前列腺癌行根治性手术或根治性放疗可以达到相似的治疗效果，故可以根据患者的身体状况和意愿进行选择。

Efficacy of Different Treatment Methods for Early Prostate Cancer Patients and Risk Factors for Biochemical Recurrence

Objective To compare the therapeutic effect of radical surgery and radical curative radiotherapyon localized early stage (T1-2N0M0) prostate cancer patients, and to analyze the associated factors forbiochemical recurrence. Methods A retrospective analysis was performed on clinical data of 269 localizedearly stage prostate cancer patients treated with radical surgery or curative radiotherapy in The First AffiliatedHospital of Xinjiang Medical University, from April 2004 to April 2012. Multivariate logistic regressionmodel was used for analyzing the risk factors of biochemical recurrence. Results Among 269 patients,PSA(prostate specific antigen) of 97 cases was increased significantly. There are several factors, T stage,Gleason score, PSA, hemoglobin(HGB) and obesity, indicated high risk for biochemical recurrence byunivariate analysis(P<0.05). Multivariate analysis showed that T stage, Gleason score, PSA and obesitywere independent high risks for biochemical recurrence of prostate cancer patients(P<0.05). The comparisonbetween two radical treatments on biochemical recurrence rate demonstrated that the overall accumulatebiochemical recurrence rate was 36.0%, thereinto, the accumulation biochemical recurrence rate was 36.5%(23/63) in radical group and 36.0%(74/206) in radical radiotherapy group; the trend of biochemical recurrencewere consistent in two groups. Biochemical recurrence rates of two radical treatments were increased aftertwo and five years. Conclusion T stage≥T2a, Gleason score≥7, PSA≥10ng/ml and obesity should beconsidered as the risk factors for biochemical recurrence. For early prostate cancer, radical surgery or radicalradiotherapy could achieve similar effect; therefore, they could be selected by patients’ physical conditions.