早期攝護腺癌之手術治療與放射治療及其預後因子

The Impact of Radical Prostatectomy and Radiotherapy in Biochemical Relapse for Stage T1-T2 Prostate Cancer

張國楨(Kuo-Chen Chang) ； 張慶雄(Ching-Hsiung Chang) ； 胡渝昌(Yu-Chang Hu) ； 陳建勳(Chien-Hsun Chen)

《放射治療與腫瘤學》 12卷1期 (2005/03) Pp. 1-7

https://doi.org/10.6316/TRO/200512(1)1

摘要

目的：以攝護腺特異抗原(prostate specific antigen, PSA)，回溯分析(retrospective analysis)，比較臨床分期為Tl-T2的局部攝護腺癌，接受放射線治療(radiation therapy)與攝護腺根除性摘除手術(radical prostatectomy)的治療結果。
材料與方法：從1991年7月至2003年7月，共有235位臨床分期為T1-T2的早期攝護腺癌病人，在本院接受放射線治療或攝護腺根除性摘除(radical prostatectomy)治療。所有的病人都有治療前的血中PSA濃度、切片的格里森分數(Gleason score)、治療前的賀爾蒙治療不超過六個月，局部治療後沒有再給予其他的輔助治療。共有119位(50.6%)接受徹底根除手術，手術後邊緣有殘餘病灶者不列入本研究的對象；接受體外放射線治療劑量小於70Gy者共有52位(22.1%)；大於等於70Gy者共有38位(16.2%)；體外放射線治療合併近接治療者共有19位(8.1%)；另外有7位(3%)接受經尿道攝護腺切除手術後加體外放射線治療。放射線治療劑量小於70Gy與大於70Gy的中值劑量分別是65.6Gy及70.2Gy。所有病人的中值追蹤時間為41.9個月。PSA值可作為對治療反應的指標，治療後PSA值多會下降，如果不正常的昇高，有可能局部復發或疾病惡化(disease progression)。臨床上都以PSA值判斷攝護腺癌預後之好壞或治療後追蹤檢查疾病有無持續存在(persistent disease)或復發(relapse)。
本研究是以臨床T分期、治療前的血中PSA濃度、Gleason分數、治療模式等變數對生化性無復發存活率(biochemical relapse free survival, bRFS)，作多項變數分析。
結果：手術與放射線治療的5年bRFS(5-year biochemical relapse free survival)分別是53.5%與59.0%，7年bRFS分別是21.3%與45.0%，多變數分析顯示手術前的血中PSA濃度(p=0.029)與Gleason分數(p=0.006)是獨立的復發預後因子，治療模式(p=0.025)與臨床T分期(p=0.53)不是PSA復發的獨立預後因子。
結論：T1-T2的局部攝護腺癌，與根除性摘除手術比較，放射線治療也有相當的治療結果，對於PSA復發的影響沒有統計上的意義。

關鍵字

局部攝護腺癌 ； 放射線治療 ； 攝護腺根除性摘除手術 ； 攝護腺特異抗原

並列摘要

Purpose: This retrospective analysis reviewed the biochemical relapse free survival rates after treatment with radiotherapy or radical prostatectomy (RP) for clinical stage Tl-T2 localized prostate cancer.
Methods and Materials: The study population comprised 235 patients treated at either Urology section or Radiation Oncology section in our institution. All patients had pretreatment prostate-specific antigen (iPSA) levels and biopsy Gleason scores (bGSs) Neoadjuvant androgen block treatment was given for less than 6 months. No adjuvant therapy was given after local therapy. 119 patients (50.6%) had undergone radical prostacteomy (RP). 52 patients (22.1%) received EBRT＜70Gy, 38 patients (16.2%) received EBRT≥70Gy, 7 patients (3%) were treated with post TURP radiotherapy and combined interstitial and radiotherapy was delivered for 19 patients (8.1%). Only patients with free surgical margin were enrolled in the group of RP, The median radiation doses in EBRT＜70Gy and EBRT≥70Gy was 65.6Gy and 70.2Gy, respectively. The median follow-up time for all patients was 41.9 months. Biochemical relapse was defined as two consecutive PSA＞0.2ng/ml for RP and three consecutive rising PSA levels (American Society for Therapeutic Radiology Oncology consensus definition) for all other cases. Cox regression multivariate analysis was performed using clinical T stage, bGS, iPSA and treatment modality.
Results: The 5-year bRFS (biological relapse free survival) for RP and radiotherapy was 53.5% and 59% respectively. The 7-year bRFS for RP and radiotherapy was 21.3% and 45% respectively. Multivariate analysis showed iPSA (p=0.029) and bGS (p=0.006) to be independent predictors of relapse. Treatment modality and clinical T stage were not independent predictors of relapse.
Conclusion: There was no significant difference between RP and radiotherapy in the view of biochemical relapse for stage T1-T2 prostate cancer

並列關鍵字

Local prostate cancer ； Radiotherapy ； Radical prostatecomy ； PSA