目的:对高危前列腺癌患者行新辅助内分泌治疗(neoadjuvant hormonal therapy,NHT)的早期疗效进行研究,并分析相关风险因素.方法:在这项研究中,时间范围为2020年1月至2023年1月,共有151例高危前列腺癌患者纳入研究,患者均接受了根治性前列腺切除术(radical prostatectomy,RP).其中,70例患者被分入了新辅助内分泌治疗(NHT组),为实现最大程度的雄激素阻断效果,术前应用促黄体生成激素释放激素类似物(luteinizing hormone-releasing hormone analogue,LHRH-A)并且加用一种非甾体类抗雄激素药物.比较NHT组治疗前后前列腺及前列腺特异性抗原(prostate specific antigen,PSA)的变化情况;81例患者直接接受前列腺癌根治性切除术,作为对照组.研究对比2组围术期指标包括手术时间长短、出血量多少、引流管留置时间长短、住院时长;同时比较2组术后病理结果包括切缘阳性率是否有差异以及Gleason评分下降情况.同时分析影响2组影响切缘阳性率的相关危险因素.结果:新辅助内分泌治疗后NHT组前列腺特异性抗原及体积明显低于治疗前,且治疗时间越长,PSA值水平降低程度越大(P＜0.05).相对于对照组,NHT组的手术时长更短,且术后病理改善:切缘阳性率更低,并且Gleason评分的下降率更大(P＜0.05);2组出血量、引流管留置时长、住院时长无显著差异(P＞0.05).2组中PSA值水平是影响切缘阳性率的危险因素.结论:通过新辅助内分泌治疗,可以降低高危前列腺癌患者的PSA值水平和前列腺体积,从而使其更适合接受手术治疗,甚至使一些无法手术的患者有可能进行根治性手术.这种治疗可以减少切缘阳性率,并使Gleason评分降低.PSA值水平是影响切缘阳性的危险因素.
Early efficacy and associated risk factors of neoadjuvant hormonal therapy for high-risk prostate cancer
Objective:To analyze the early efficacy and associated risk factors of neoadjuvant hormonal therapy(NHT)for high-risk prostate cancer(hrPC).Methods:From January 2020 to January 2023,a total of 151 patients with hrPC who underwent radical prosta-tectomy(RP)were included in this study.Of these 151 patients,70 were assigned to the NHT group and received luteinizing hormone-releasing hormone analogue(LHRH-A)combined with nonsteroidal antiandrogen agent before RP to maximize androgen blockade.Alterations in prostate volume and prostate specific antigen(PSA)levels were examined post-treatment in the NHT group.The other 81 patients were assigned to the control group and underwent direct RP.Perioperative parameters,including surgical time,intraopera-tive bleeding,drainage tube retention time,and length of hospital stay,as well as postoperative positive surgical margin(PSM)rate and decrease in Gleason score were compared between the two groups.In addition,the risk factors associated with PSM rate were also analyzed.Results:PSA levels and prostate volume were significantly decreased after treatment in the NHT group,with the extent of PSA decrease correlated with the duration of treatment(P＜0.05).Compared with the control group,the NHT group had a shorter surgical time,a lower postoperative PSM rate,and a greater decrease in Gleason score than the control group(all P＜0.05).However,there were no significant differences in intraoperative bleeding,drainage tube retention time,and length of hospital stay between the two groups(all P＞0.05).PSA level was a risk factor for PSM rate in both groups.Conclusion:NHT can reduce PSA levels and prostate vol-ume,rendering hrPC patients more amenable to surgery and making RP possible for those who were previously deemed unsuitable for surgery.In addition,NHT can lower PSM rate and decrease Gleason score.PSA value is a risk factor for PSM.
万方数据
维普
