Clinical outcomes and predictors of ≤cT3 prostate cancer treated by 125I low-dose-rate prostate brachytherapy
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摘要: 目的 分析125I粒子植入近距离放疗治疗≤cT3期前列腺癌的临床效果，探讨影响术后无生化复发生存率(biochemical relapse-free survival，bRFS)和总生存率(overall survival，OS)的相关因素。方法 回顾性分析2006年1月—2016年12月于天津医科大学第二医院经125I粒子植入放疗的116例≤cT3期前列腺癌患者的临床资料。采用Kaplan-Meier法统计患者术后5、8年的bRFS、OS；分别采用Log-rank法和Cox比例风险模型评估穿刺活检前前列腺特异性抗原(PSA)值、穿刺病理Gleason评分、临床T分期、穿刺活检阳性针数率、危险度分级、前列腺体积与患者术后bRFS、OS的关系。结果 5、8年bRFS分别为75.0%、56.0%；5、8年OS分别为80.2%、62.1%；Gleason评分、穿刺活检阳性针数率、临床T分期、前列腺体积是bRFS的独立预测因素，而Gleason评分、临床T分期是OS的独立预测因素(P < 0.05)；对于≤cT3a期前列腺癌，Gleason评分、穿刺活检阳性针数率、前列腺体积、危险度分级均是bRFS独立预测因素(P < 0.05)，而Gleason评分是OS的独立预测因素(P < 0.05)。结论 125I粒子植入治疗低危组前列腺癌效果理想；中、高危组，尤其是T3a~T3b期及Gleason评分≥8分者，应考虑结合外放疗和内分泌治疗；腺体体积较大不影响术后bRFS和OS；穿刺活检阳性针数率偏高者，术后应加强对PSA值的监测，必要时行穿刺活检，明确复发原因，并给予针对性治疗。Abstract: Objective To evaluate the outcomes of low-dose-rate prostate brachytherapy(LDR-BT) and investigate the prognostic factors of biochemical relapse-free survival(bRFS) and overall survival(OS) in ≤cT3 prostate cancer after LDR-BT.Methods One hundred and sixteen patients with ≤cT3 prostate cancer treated with 125I LDR-BT as monotherapy or combined with homonal therapyfrom Jan, 2006 to Dec, 2016 in Second Hospital of Tianjin Medical University were retrospectively collected. Log-rank test and multivariable Cox regression were used to evaluate the relationship between covariates (PSA, clinical stage, prostate volume, et. al) and bRFS, OS.Results Five- and eight-year bRFS and OS were 75.0% and 56.0%, 80.2% and 62.1%, respectively; Multivariate Cox analysis showed that Gleason score, the percentage of positive biopsy cores(%PC), clinical T stage and PV were correlated with bRFS; Gleason score and clinical T stage were correlated with OS; For patients with ≤cT3a prostate cancer, Gleason score, %PC, PV and risk group were correlated with bRFS; Only Gleason score was an independent predictor of OS.Conclusion Low-risk PCa patients are the most suitable candidates for LDR-BT, while the intermediate- or high-risk PCa, specially for stage cT3a-cT3b or Gleason score≥8, LDR-BT combined with external radiotherapy and hormone therapy may be considered. Very large PV does not influence bRFS rate or OS. The PCa with high %PC should be paid more attention to biochemical recurrence(BCR), even biopsy when necessary, to clarify the cause of BCR for definite therapy.
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Key words:
- prostate cancer /
- brachytherapy /
- biochemical recurrence /
- risk factor
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表 1 不同影响因素分层下LDR-BT术后bRFS和OS情况
例(%) 影响因素 例数 bRFS OS 5年 8年 5年 8年 术前PSA/(ng/mL) <10 47 39(83.0) 30(63.8) 41(87.2) 34(72.3) 10~20 47 33(70.2) 26(55.3) 38(80.9) 29(61.7) >20 22 15(68.2) 9(40.9) 14(63.6) 9(40.9) Gleason评分 ≤6 41 36(87.8) 29(70.7) 37(90.2) 33(80.5) 7 42 33(78.6) 26(62.0) 35(83.3) 27(64.3) ≥8 33 18(54.5) 10(30.3) 21(63.6) 12(36.4) 前列腺体积/mL ≤60 53 33(62.3) 27(50.9) 38(71.7) 29(54.7) >60 63 54(85.7) 38(60.3) 55(87.3) 43(66.7) 穿刺活检阳性针数率 ≤50% 59 46(78.0) 41(69.5) 50(84.7) 38(64.4) >50% 57 41(72.0) 24(42.1) 43(75.4) 34(59.6) 临床T分期 ≤T2a 44 38(86.4) 31(70.5) 38(86.4) 30(68.2) T2b 36 26(72.2) 19(52.8) 30(83.3) 23(63.9) T2c 12 9(75.0) 7(58.3) 9(75.0) 7(58.3) T3a 14 10(71.4) 6(42.9) 10(71.4) 8(57.1) T3b 10 4(40.0) 2(20.0) 6(60.0) 4(40.0) 危险因素分级 低危 22 19(86.4) 16(72.7) 20(90.9) 19(86.4) 中危 41 34(82.9) 27(65.9) 34(82.9) 26(63.4) 高危 53 34(64.2) 22(41.5) 39(73.6) 27(50.9) 
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