Comparative of the surgical clinical outcomes between RARP after neoadjuvant hormonal therapy and RARP alone for oligometastatic prostate cancer
-
摘要: 目的:比较新辅助内分泌治疗(NHT)后行机器人辅助腹腔镜根治性前列腺切除术(RARP)与仅行RARP治疗寡转移性前列腺癌(PCa)的短期临床疗效。方法:回顾性分析2015年1月—2020年8月期间南昌大学第一附属医院确诊的50例寡转移性PCa患者的临床资料,根据术前是否行NHT分为NHT+RARP组(20例)和RARP组(30例),收集统计所有患者的一般临床资料及围手术期资料。结果:两组手术均获得成功,无中转开放手术。两组的手术时间、术中估计出血量、切缘阳性、精囊侵犯、Clavien-Dindo手术并发症分级以及术后住院时间比较,差异均无统计学意义;而两组在包膜侵犯、尖端阳性及术后病理T分期方面进行比较,差异均有统计学意义。NHT+RARP组经NHT治疗后可明显缩小术前前列腺体积、降低血清前列腺特异性抗原(PSA)水平,且差异有统计学意义。结论:在寡转移性PCa患者中行NHT可潜在地获益,可明显降低术前血清PSA水平、缩小前列腺体积,同时可降低包膜侵犯和尖端阳性的风险,但并没有显著降低手术时间、术中估计出血量、术后住院时间、术后Gleason评分、精囊侵犯、淋巴结阳性以及手术切缘阳性结果。因此,对于寡转移性PCa患者而言,术前行NHT是一种可选择的治疗方式,尤其是术前高PSA水平、前列腺体积较大的患者。Abstract: Objective: To compare the surgical clinical outcomes of robot-assisted laparoscopic radical prostatectomy(RARP) after neoadjuvant hormonal therapy(NHT) and RARP alone in the treatment of oligometastatic prostate cancer.Methods: A retrospective analysis of the clinical data of 50 patients with oligometastatic prostate cancer diagnosed in First Affiliated Hospital of Nanchang University from January 2015 to August 2020 was done. According to whether NHT was performed before surgery, they were divided into NHT+RARP group 20 cases and RARP group 30 cases. The general clinical data and perioperative data of all included patients were collected and statistically analyzed.Results: All operation of both groups were successful, and there was no transfer to open surgery. There was no significant difference between the two groups in operation time, estimated intraoperative blood loss, positive resection margin, seminal vesicle invasion, Clavien-Dindo surgical complications classification, or postoperative hospital stay. The difference between the two groups in terms of capsule invasion, apex of prostate positive and postoperative pathological T staging was statistically significant. After NHT treatment in the NHT+RARP group, the preoperative prostate volume and the serum prostate-specific antigen(PSA) level can be significantly reduced, and the difference was statistically significant.Conclusion: Patients with oligometastatic prostate cancer can potentially benefit from NHT. It can significantly reduce preoperative serum PSA levels and prostate volume, while reducing the risk of capsule invasion and apex of prostate positive, but it does not significantly reduce the operation time of surgery, estimated intraoperative blood loss, postoperative hospital stay, postoperative Gleason score, positive rate of seminal vesicle invasion, lymph node or surgical resection margin. Therefore, for patients with oligometastatic prostate cancer, preoperative NHT is an alternative treatment, especially those with high PSA level and larger prostate volume.
-
Key words:
- prostate cancer /
- oligometastases /
- neoadjuvant hormonal therapy /
- radical prostatectomy
-
-
[1] Siegel RL,Miller KD,Fuchs HE,et al.Cancer Statistics,2021[J].CA Cancer J Clin,2021,71(1):7-33.
[2] Liu X,Yu C,Bi Y,et al.Trends and age-period-cohort effect on incidence and mortality of prostate cancer from 1990 to 2017 in China[J].Public Health,2019,172:70-80.
[3] Thomas TS,Pachynski RK.Treatment of Advanced Prostate Cancer[J].Mo Med,2018,115(2):156-161.
[4] James ND,Spears MR,Clarke NW,et al.Survival with Newly Diagnosed Metastatic Prostate Cancer in the "Docetaxel Era":Data from 917 Patients in the Control Arm of the STAMPEDE Trial(MRC PR08,CRUK/06/019)[J].Eur Urol,2015,67(6):1028-1038.
[5] Bayne CE.Re:Stephen H.Culp,Paul F.Schellhammer,Michael B.Williams.Might men diagnosed with metastatic prostate cancer benefit from definitive treatment of the primary tumor?A SEER-based study.Eur Urol 2014;65:1058-66[J].Eur Urol,2014,65(6):e99.
[6] Thompson IM,Tangen C,Basler J,et al.Impact of previous local treatment for prostate cancer on subsequent metastatic disease[J].J Urol,2002,168(3):1008-1012.
[7] Sooriakumaran P,Nyberg T,Akre O,et al.Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer:observational study of mortality outcomes[J].BMJ,2014,348:g1502.
[8] Gratzke C,Engel J,Stief CG.Role of radical prostatectomy in metastatic prostate cancer:data from the Munich Cancer Registry[J].Eur Urol,2014,66(3):602-603.
[9] Johnston TJ,Shaw GL,Lamb AD,et al.Mortality Among Men with Advanced Prostate Cancer Excluded from the ProtecT Trial[J].Eur Urol,2017,71(3):381-388.
[10] Mottet N,Ornford P,Alrb E.EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer[OL].Eur Urol,2020.
[11] Shelley MD,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 Treat Rev,2009,35(1):9-17.
[12] Hajili T,Ohlmann CH,Linxweiler J,et al.Radical prostatectomy in T4 prostate cancer after inductive androgen deprivation:results of a single-institution series with long-term follow-up[J].BJU Int,2019,123(1):58-64.
[13] Hellman S,Weichselbaum RR.Oligometastases[J].J Clin Oncol,1995,13(1):8-10.
[14] Stevens DJ,Sooriakumaran P.Oligometastatic Prostate Cancer[J].Curr Treat Options Oncol,2016,17(12):62.
[15] Tosoian JJ,Gorin MA,Ross AE,et al.Oligometastatic prostate cancer:definitions,clinical outcomes,and treatment considerations[J].Nat Rev Urol,2017,14(1):15-25.
[16] Farolfi A,Calderoni L,Mattana F,et al.Current and Emerging Clinical Applications of PSMA PET Diagnostic Imaging for Prostate Cancer[J].J Nucl Med,2021,62(5):596-604.
[17] Parker CC,James ND,Brawley CD,et al.Radiotherapy to the primary tumour for newly diagnosed,metastatic prostate cancer(STAMPEDE):a randomised controlled phase 3 trial[J].Lancet,2018,392(10162):2353-2366.
[18] Boevé L,Hulshof M,Vis AN,et al.Effect on Survival of Androgen Deprivation Therapy Alone Compared to Androgen Deprivation Therapy Combined with Concurrent Radiation Therapy to the Prostate in Patients with Primary Bone Metastatic Prostate Cancer in a Prospective Randomised Clinical Trial:Data from the HORRAD Trial[J].Eur Urol,2019,75(3):410-418.
[19] Tilki D,Pompe RS,Bandini M,et al.Local treatment for metastatic prostate cancer:A systematic review[J].Int J Urol,2018,25(5):390-403.
[20] Sanda MG,Cadeddu JA,Kirkby E,et al.Clinically Localized Prostate Cancer:AUA/ASTRO/SUO Guideline.Part II:Recommended Approaches and Details of Specific Care Options[J].J Urol,2018,199(4):990-997.
[21] NCCN clinical practice guidelines in oncology prostate cancer version 4[OL].[2018-03-08].http:www.nccn.org/patients.
[22] Heidenreich A,Pfister D,Porres D.Cytoreductive radical prostatectomy in patients with prostate cancer and low volume skeletal metastases:results of a feasibility and case-control study[J].J Urol,2015,193(3):832-838.
[23] Pan J,Chi C,Qian H,et al.Neoadjuvant chemohormonal therapy combined with radical prostatectomy and extended PLND for very high risk locally advanced prostate cancer:A retrospective comparative study[J].Urol Oncol,2019,37(12):991-998.
[24] Ma BL,Yao L,Fan Y,et al.Short-term benefit of neoadjuvant hormone therapy in patients with localized high-risk or limited progressive prostate cancer[J].Cancer Manag Res,2019,11:4143-4151.
[25] 施江龙.新辅助内分泌治疗对前列腺癌根治术后病理评分和手术参数的影响[D].郑州:郑州大学,2018
[26] Kim SH,Park EY,Joo J,et al.Effect of Neoadjuvant Hormone Therapy on Resection Margin and Survival Prognoses in Locally Advanced Prostate Cancer after Prostatectomy Using Propensity-Score Matching[J].Biomed Res Int,2018,2018:4307207.
[27] Kumar S,Shelley M,Harrison C,et al.Neo-adjuvant and adjuvant hormone therapy for localised and locally advanced prostate cancer[J].Cochrane Database Syst Rev,2006,(4):CD006019.
[28] Stephen T,Ryan MD,Devin N,et al.Neoadjuvant Approaches Prior To Radical Prostatectomy[J].Cancer J,2020,26(1):1-12.
[29] Bostwick DG,Bostwick KC.'Vanishing' prostate cancer in radical prostatectomy specimens:incidence and long-term follow-up in 38 cases[J].BJU Int,2004,94(1):57-58.
[30] Joung JY,Kim JE,Kim SH,et al.The prevalence and outcomes of pT0 disease after neoadjuvant hormonal therapy and radical prostatectomy in high-risk prostate cancer[J].BMC Urol,2015,15:82.
[31] McKay RR,Xie W,Ye H,et al.Results of a Randomized Phase II Trial of Intense Androgen Deprivation Therapy prior to Radical Prostatectomy in Men with High-Risk Localized Prostate Cancer[J].J Urol,2021,206(1):80-87.
[32] McKay RR,Ye H,Xie W,et al.Evaluation of Intense Androgen Deprivation Before Prostatectomy:A Randomized Phase II Trial of Enzalutamide and Leuprolide With or Without Abiraterone[J].J Clin Oncol,2019,37(11):923-931.
-
计量
- 文章访问数: 208
- PDF下载数: 88
- 施引文献: 0
下载: