经皮局灶冷冻消融治疗局限性前列腺癌17例疗效分析
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摘要
目的评价经皮局灶冷冻消融治疗局限性前列腺癌的疗效及安全性。方法前瞻性收集2014年3月至2017年1月于我院行经皮局灶冷冻消融治疗的17例局限性前列腺癌患者的临床病例资料并进行随访研究。所有患者在确诊后均行经直肠超声引导靶向主要病灶(index lesion)的经皮局灶冷冻消融治疗。研究主要终点为冷冻治疗前后的PSA变化情况。结果所有患者术后tPSA比术前明显下降,总体由术前(11.99±4.15)ng/mL降至术后(1.78±1.73)ng/mL,差异具统计学意义(P<0.0001)。其中,低危组由(8.66±0.96)ng/mL降至(1.23±1.01)ng/mL(P <0.0001),中危组由(12.12±3.83)ng/mL降至(1.41±1.27)ng/mL(P <0.0001),高危组由(16.02±4.85)ng/mL降至(3.72±2.84)ng/mL(P<0.0001)。所有患者术后均无明显并发症。结论经皮局灶冷冻消融有可能成为局限性前列腺癌患者的有效治疗方式,具有疗效确切、并发症少、安全、微创等优点。但该技术目前尚处于起步探索阶段,缺乏对患者远期疗效的评估,因此需要进一步累积病例数及临床经验以得出明确结论。
Objectives To evaluate the efficacy and safety of percutaneous focal cryoablation targeted index lesion in the treatment of localized prostate cancer. Methods Seventeen patients who were diagnosed as localized prostate cancer by pathological and imaging examination from Mar. 2014 to Jan. 2017 were recruited in the study. All patients received percutaneous focal cyroablation targeting index lesion after signing the informed consent. The variation of serum PSA before and after cryoablation was comparatively analyzed. Results Serum tPSA levels of the treated patients with focal cryoablation were decreased significantly from a mean baseline value of 11.99±4.15 ng/mL to 1.78±1.73 ng/mL(P<0.0001). For the patients with low-, intermediate-and high-risk prostate cancer, their tPSA levels were changed from 8.66±0.96 ng/mL to 1.23±1.01 ng/mL, 12.12±3.83 ng/mL to 1.41±1.27 ng/mL, and 16.02±4.85 ng/mL to 3.72±2.84 ng/mL(P <0.0001), separately. No severe complications were observed. Conclusion Percutaneous focal cryoablation targeting index lesion could be an effective and safe method for patients with localized prostate cancer, with advantages in little surgery related complications and rapid recovery characteristics. But better designed clinical trials with more patients, longer follow-up merit to be further carried out due to a lack of proofs concerning the long-term efficacy, including the overall survival(OS), disease specific survival(DSS).
Objectives To evaluate the efficacy and safety of percutaneous focal cryoablation targeted index lesion in the treatment of localized prostate cancer. Methods Seventeen patients who were diagnosed as localized prostate cancer by pathological and imaging examination from Mar. 2014 to Jan. 2017 were recruited in the study. All patients received percutaneous focal cyroablation targeting index lesion after signing the informed consent. The variation of serum PSA before and after cryoablation was comparatively analyzed. Results Serum tPSA levels of the treated patients with focal cryoablation were decreased significantly from a mean baseline value of 11.99±4.15 ng/mL to 1.78±1.73 ng/mL(P<0.0001). For the patients with low-, intermediate-and high-risk prostate cancer, their tPSA levels were changed from 8.66±0.96 ng/mL to 1.23±1.01 ng/mL, 12.12±3.83 ng/mL to 1.41±1.27 ng/mL, and 16.02±4.85 ng/mL to 3.72±2.84 ng/mL(P <0.0001), separately. No severe complications were observed. Conclusion Percutaneous focal cryoablation targeting index lesion could be an effective and safe method for patients with localized prostate cancer, with advantages in little surgery related complications and rapid recovery characteristics. But better designed clinical trials with more patients, longer follow-up merit to be further carried out due to a lack of proofs concerning the long-term efficacy, including the overall survival(OS), disease specific survival(DSS).
引文
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2 韩苏军,张思维,陈万青,等.中国前列腺癌发病现状和流行趋势分析.临床肿瘤学杂志2013; 18(4):330-334
3 陈祎颿,丁杰,钱苏波,等.冷冻治疗在前列腺癌中的应用.现代泌尿外科杂志2015; 20(12):919-921
4 Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1:screening, diagnosis,and local treatment with curative intent. Eur Urol2017;71(4):618-629
5 Ahmed HU, Dickinson L, Charman S, et al. Focal ablation targeted to the index lesion in multifocal localised prostate cancer:a prospective development study. Eur Urol2015;68(6):927-936
6 Cox JD, Gallagher MJ, Hammond EH, et al. Consensus statementsonradiationtherapyofprostatecancer:guidelinesforprostatere-biopsyafterradiationandfor radiationtherapywithrisingprostate-specificantigen levels after radical prostatectomy. American Society for Therapeutic Radiology and Oncology Consensus Panel. J Clin Oncol1999; 17(4):1155
7 RoachM3rd,HanksG, ThamesHJr, etal.Defining biochemicalfailurefollowingradiotherapywithor without hormonal therapy in men with clinically localized prostate cancer:recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 2006; 65(4):965-974
8 Ahmed HU, Pendse D, Illing R, et al. Will focal therapy become a standard of care for men with localized prostate cancer? Nat Clin Pract Oncol2007; 4(11):632-642
9 AhmedHU, AkinO,ColemanJA, etal. Transatlantic Consensus Group on active surveillance and focal therapy for prostate cancer. BJU Int2012; 109(11):1636-1647
10 Ahmed HU. The index lesion and the origin of prostate cancer. N Engl J Med 2009; 361(17):1704-1706
11 Carter HB, Partin AW, Walsh PC, et al. Gleason score 6adenocarcinoma:shoulditbelabeledascancer? J Clin Oncol2012; 30(35):4294-4296.
12 AhmedHU, AryaM,Freeman A, etal.Dolow-grade andlow-volumeprostatecancersbearthehallmarksof malignancy? Lancet Oncol2012; 13(11):e509-e517
13 vanderPoelHG,vandenBerghRCN,BriersE, etal.Focaltherapyinprimarylocalisedprostatecancer:the European AssociationofUrologyPositionin2018. Eur Urol2018; 74(1):84-91
14 Ahmed HU, Freeman A, Kirkham A, et al. Focal therapy forlocalizedprostatecancer:aphaseI/IItrial.JUrol2011; 185(4):1246-1254
15 AhmedHU,HindleyRG,DickinsonL,etal.Focal therapyforlocalisedunifocalandmultifocalprostate cancer:aprospectivedevelopmentstudy. Lancet Oncol2012; 13(6):622-632
16 ValerioM, AhmedHU,EmbertonM, et al. Theroleof focaltherapyinthemanagementoflocalisedprostate cancer:a systematic review. Eur Urol2014; 66(4):732-751.
17 连惠波,郭宏骞,甘卫东,等.局限性前列腺癌冷冻治疗的初步报告.中华外科杂志2010; 48(10):798-799
18 连惠波,汪唯,杨荣,等.冷冻治疗单病灶前列腺癌12例临床分析.中华泌尿外科杂志2011; 32(9):588-590
2 韩苏军,张思维,陈万青,等.中国前列腺癌发病现状和流行趋势分析.临床肿瘤学杂志2013; 18(4):330-334
3 陈祎颿,丁杰,钱苏波,等.冷冻治疗在前列腺癌中的应用.现代泌尿外科杂志2015; 20(12):919-921
4 Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1:screening, diagnosis,and local treatment with curative intent. Eur Urol2017;71(4):618-629
5 Ahmed HU, Dickinson L, Charman S, et al. Focal ablation targeted to the index lesion in multifocal localised prostate cancer:a prospective development study. Eur Urol2015;68(6):927-936
6 Cox JD, Gallagher MJ, Hammond EH, et al. Consensus statementsonradiationtherapyofprostatecancer:guidelinesforprostatere-biopsyafterradiationandfor radiationtherapywithrisingprostate-specificantigen levels after radical prostatectomy. American Society for Therapeutic Radiology and Oncology Consensus Panel. J Clin Oncol1999; 17(4):1155
7 RoachM3rd,HanksG, ThamesHJr, etal.Defining biochemicalfailurefollowingradiotherapywithor without hormonal therapy in men with clinically localized prostate cancer:recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 2006; 65(4):965-974
8 Ahmed HU, Pendse D, Illing R, et al. Will focal therapy become a standard of care for men with localized prostate cancer? Nat Clin Pract Oncol2007; 4(11):632-642
9 AhmedHU, AkinO,ColemanJA, etal. Transatlantic Consensus Group on active surveillance and focal therapy for prostate cancer. BJU Int2012; 109(11):1636-1647
10 Ahmed HU. The index lesion and the origin of prostate cancer. N Engl J Med 2009; 361(17):1704-1706
11 Carter HB, Partin AW, Walsh PC, et al. Gleason score 6adenocarcinoma:shoulditbelabeledascancer? J Clin Oncol2012; 30(35):4294-4296.
12 AhmedHU, AryaM,Freeman A, etal.Dolow-grade andlow-volumeprostatecancersbearthehallmarksof malignancy? Lancet Oncol2012; 13(11):e509-e517
13 vanderPoelHG,vandenBerghRCN,BriersE, etal.Focaltherapyinprimarylocalisedprostatecancer:the European AssociationofUrologyPositionin2018. Eur Urol2018; 74(1):84-91
14 Ahmed HU, Freeman A, Kirkham A, et al. Focal therapy forlocalizedprostatecancer:aphaseI/IItrial.JUrol2011; 185(4):1246-1254
15 AhmedHU,HindleyRG,DickinsonL,etal.Focal therapyforlocalisedunifocalandmultifocalprostate cancer:aprospectivedevelopmentstudy. Lancet Oncol2012; 13(6):622-632
16 ValerioM, AhmedHU,EmbertonM, et al. Theroleof focaltherapyinthemanagementoflocalisedprostate cancer:a systematic review. Eur Urol2014; 66(4):732-751.
17 连惠波,郭宏骞,甘卫东,等.局限性前列腺癌冷冻治疗的初步报告.中华外科杂志2010; 48(10):798-799
18 连惠波,汪唯,杨荣,等.冷冻治疗单病灶前列腺癌12例临床分析.中华泌尿外科杂志2011; 32(9):588-590