局部晚期前列腺癌手术治疗策略及疗效
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摘要
前列腺癌是全球男性最常见的恶性肿瘤之一。局部晚期前列腺癌是指肿瘤突破了前列腺包膜,侵犯精囊或邻近组织(T_(3a)-T_4),和/或合并有区域淋巴结转移,没有远处转移的前列腺癌(cT_(3a)-4N_(0-1)M_0)。局部晚期前列腺癌恶性程度高,复发转移率高。过去由于较高的手术切缘阳性率和术后并发症发生率,局部晚期前列腺癌不推荐手术治疗。然而,手术技术的改进及综合内分泌治疗使得这些患者的预后优于局部放疗或放疗联合内分泌治疗。主要针对局部晚期前列腺癌外科治疗的合理性与优势、预后、扩大淋巴结清扫意义及并发症等进行述评。
Prostate cancer is the most common malignancy in men worldwide. Locally advanced prostate cancer is characterized by extracapsular extension( pT_(3a)),invasion of the seminal vesicles( pT_(3b)),invasion of adjacent organs(T_4),and/or positive regional lymph node but no distant metastasis. Locally advanced prostate cancer shows remarkably malignant behavior and a high rate of recurrence and metastasis. In the past,surgical treatment was considered unfavorable for locally advanced prostate cancer due to the high positive surgical margin rates and increased complication rates. However,improvements in surgical techniques and combined endocrine therapy have enabled the outcomes for these patients as compared to local radiotherapy or radiotherapy combined with endocrine therapy. This paper reviews the rationality and advantages,prognosis,extensive lymph node dissection,and complications of surgical treatment in patients with locally advanced prostate cancer.
Prostate cancer is the most common malignancy in men worldwide. Locally advanced prostate cancer is characterized by extracapsular extension( pT_(3a)),invasion of the seminal vesicles( pT_(3b)),invasion of adjacent organs(T_4),and/or positive regional lymph node but no distant metastasis. Locally advanced prostate cancer shows remarkably malignant behavior and a high rate of recurrence and metastasis. In the past,surgical treatment was considered unfavorable for locally advanced prostate cancer due to the high positive surgical margin rates and increased complication rates. However,improvements in surgical techniques and combined endocrine therapy have enabled the outcomes for these patients as compared to local radiotherapy or radiotherapy combined with endocrine therapy. This paper reviews the rationality and advantages,prognosis,extensive lymph node dissection,and complications of surgical treatment in patients with locally advanced prostate cancer.
引文
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[10]Srivatsa N,Nagaraja H,Shweta S,et al.Radical prostatectomy for locally advanced prostate cancers-reviewof literature[J].Indian J Surg Oncol,2017,8(2):175-180.
[11]Briganti A,Karnes JR,Da Pozzo LF,et al.Two positive nodes represent a significant cut-off value for cancer specific survival in patients with node positive prostate cancer.A newproposal based on a two-institution experience on 703 consecutive N+patients treated with radical prostatectomy,extended pelvic lymph node dissection and adjuvant therapy[J].Eur Urol,2009,55(2):261-270.
[12]Nickers P,Lartigau E.Re:Chao-Yu Hsu,Steven Joniau,Raymond Oyen et al.Outcome of surgery for clinical unilateral T3a prostate cancer:a single-institution experience.Eur Urol 2007;51:121-9[J].Eur Urol,2007,52(2):612.doi:10.1016/j.eururo.2007.03.048.
[13]Freedland SJ,Partin AW,Humphreys EB,et al.Radical prostatectomy for clinical stage T3a disease[J].Cancer,2007,109(7):1273-1278.
[14]Joniau S,Hsu CY,Gontero P,et al.Radical prostatectomy in very high-risk localized prostate cancer:longterm outcomes and outcome predictors[J].Scand J Urol Nephrol,2012,46(3):164-171.
[15]Moltzahn F,Karnes J,Gontero P,et al.Predicting prostate cancer-specific outcome after radical prostatectomy among men with very high-risk c T3b/4 PCa:a multi-institutional outcome study of 266 patients[J].Prostate Cancer Prostatic Dis,2015,18(1):31-37.
[16]Johnstone PA,Ward KC,Goodman M,et al.Radical prostatectomy for clinical T4 prostate cancer[J].Cancer,2006,106(12):2603-2609.
[17]Sussman R,Carvalho FLF,Harbin A,et al.Survival and secondary interventions following treatment for locally-advanced prostate cancer[J].Can J Urol,2018,25(5):9516-9524.
[18]Moschini M,Briganti A,Murphy CR,et al.Outcomes for patients with clinical lymphadenopathy treated with radical prostatectomy[J].Eur Urol,2016,69(2):193-196.
[19]G9zen AS,Akin Y,Ates M,et al.Impact of laparoscopic radical prostatectomy on clinical T3 prostate cancer:experience of a single centre with long-term followup[J].BJU Int,2015,116(1):102-108.
[20]Mayor de Castro J,Ca1o Velasco J,Aragón Chamizo J,et al.Locally advanced prostate cancer.Definition,diagnosis and treatment[J].Arch Esp Urol,2018,71(3):231-238.
[21]Zhao F,Shen JY,Yuan ZG,et al.Trends in treatment for prostate cancer in China:preliminary patterns of care study in a single institution[J].J Cancer,2018,9(10):1797-1803.
[22]Mattei A,Fuechsel FG,Bhatta Dhar N,et al.The template of the primary lymphatic landing sites of the prostate should be revisited:results of a multimodality mapping study[J].Eur Urol,2008,53(1):118-125.
[23]Kim KH,Rha KH.Re:Steven Joniau,Laura Van den Bergh,Evelyne Lerut,et al.Mapping of pelvic lymph node metastases in prostate cancer.Eur Urol 2013;63:450-8[J].Eur Urol,2013,64(3):e55-e56.doi:10.1016/j.eururo.2013.05.038.
[24]Moschini M,Fossati N,Abdollah F,et al.Determinants of long-term survival of patients with locally advanced prostate cancer:the role of extensive pelvic lymph node dissection[J].Prostate Cancer Prostatic Dis,2016,19(1):63-67.
[25]Pang C,Guan YY,Li HB,et al.Urologic cancer in China[J].Jpn J Clin Oncol,2016,46(6):497-501.
[26]Yao XD,Liu XJ,Zhang SL,et al.Perioperative complications of radical retropubic prostatectomy in patients with locally advanced prostate cancer:a comparison with clinically localized prostate cancer[J].Asian J Androl,2013,15(2):241-245.
[27]Gandaglia G,De Lorenzis E,Novara G,et al.Robotassisted radical prostatectomy and extended pelvic lymph node dissection in patients with locally-advanced prostate cancer[J].Eur Urol,2017,71(2):249-256.
[28]潘家骅,迟辰斐,董柏君,等.多西他赛联合全雄阻断新辅助疗法治疗高危局部进展性前列腺癌的安全性[J].上海交通大学学报(医学版),2017,37(6):797-802.PAN Jiahua,CHI Chenfei,DONG Baijun,et al.Safety of neoadjuvant chemo-hormonal therapy by the combination of docetaxel and maximal androgen blockage for locally advanced prostate cancer[J].Journal of Shanghai Jiaotong University(Medical Science),2017,37(6):797-802.(编辑:相峰)
[2]Chen WQ,Zheng RS,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[3]Chen R,Ren SC,Chinese Prostate Cancer Consortium,et al.Prostate cancer in Asia:a collaborative report[J].Asian J Urol,2014,1(1):15-29.
[4]D'Amico AV,Schultz D,Loffredo M,et al.Biochemical outcome following external beam radiation therapy with or without androgen suppression therapy for clinically localized prostate cancer[J].JAMA,2000,284(10):1280-1283.
[5]Mottet N,Bellmunt J,Bolla M,et al.EAU-ESTRO-SI-OG guidelines on prostate cancer.part 1:screening,diagnosis,and local treatment with curative intent[J].Eur Urol,2017,71(4):618-629.
[6]Veeratterapillay R,Goonewardene SS,Barclay J,et al.Radical prostatectomy for locally advanced and metastatic prostate cancer[J].Ann R Coll Surg Engl,2017,99(4):259-264.
[7]Suardi N,Dell'Oglio P,Gallina A,et al.Evaluation of positive surgical margins in patients undergoing robot-assisted and open radical prostatectomy according to preoperative risk groups[J].Urol Oncol,2016,34(2):57.e1-57.e7.doi:10.1016/j.urolonc.2015.08.019.
[8]Hager B,Kraywinkel K,Keck B,et al.Increasing use of radical prostatectomy for locally advanced prostate cancer in the USA and Germany:a comparative population-based study[J].Prostate Cancer Prostatic Dis,2017,20(1):61-66.
[9]Mitchell CR,Boorjian SA,Umbreit EC,et al.20-Year survival after radical prostatectomy as initial treatment for c T3 prostate cancer[J].BJU Int,2012,110(11):1709-1713.
[10]Srivatsa N,Nagaraja H,Shweta S,et al.Radical prostatectomy for locally advanced prostate cancers-reviewof literature[J].Indian J Surg Oncol,2017,8(2):175-180.
[11]Briganti A,Karnes JR,Da Pozzo LF,et al.Two positive nodes represent a significant cut-off value for cancer specific survival in patients with node positive prostate cancer.A newproposal based on a two-institution experience on 703 consecutive N+patients treated with radical prostatectomy,extended pelvic lymph node dissection and adjuvant therapy[J].Eur Urol,2009,55(2):261-270.
[12]Nickers P,Lartigau E.Re:Chao-Yu Hsu,Steven Joniau,Raymond Oyen et al.Outcome of surgery for clinical unilateral T3a prostate cancer:a single-institution experience.Eur Urol 2007;51:121-9[J].Eur Urol,2007,52(2):612.doi:10.1016/j.eururo.2007.03.048.
[13]Freedland SJ,Partin AW,Humphreys EB,et al.Radical prostatectomy for clinical stage T3a disease[J].Cancer,2007,109(7):1273-1278.
[14]Joniau S,Hsu CY,Gontero P,et al.Radical prostatectomy in very high-risk localized prostate cancer:longterm outcomes and outcome predictors[J].Scand J Urol Nephrol,2012,46(3):164-171.
[15]Moltzahn F,Karnes J,Gontero P,et al.Predicting prostate cancer-specific outcome after radical prostatectomy among men with very high-risk c T3b/4 PCa:a multi-institutional outcome study of 266 patients[J].Prostate Cancer Prostatic Dis,2015,18(1):31-37.
[16]Johnstone PA,Ward KC,Goodman M,et al.Radical prostatectomy for clinical T4 prostate cancer[J].Cancer,2006,106(12):2603-2609.
[17]Sussman R,Carvalho FLF,Harbin A,et al.Survival and secondary interventions following treatment for locally-advanced prostate cancer[J].Can J Urol,2018,25(5):9516-9524.
[18]Moschini M,Briganti A,Murphy CR,et al.Outcomes for patients with clinical lymphadenopathy treated with radical prostatectomy[J].Eur Urol,2016,69(2):193-196.
[19]G9zen AS,Akin Y,Ates M,et al.Impact of laparoscopic radical prostatectomy on clinical T3 prostate cancer:experience of a single centre with long-term followup[J].BJU Int,2015,116(1):102-108.
[20]Mayor de Castro J,Ca1o Velasco J,Aragón Chamizo J,et al.Locally advanced prostate cancer.Definition,diagnosis and treatment[J].Arch Esp Urol,2018,71(3):231-238.
[21]Zhao F,Shen JY,Yuan ZG,et al.Trends in treatment for prostate cancer in China:preliminary patterns of care study in a single institution[J].J Cancer,2018,9(10):1797-1803.
[22]Mattei A,Fuechsel FG,Bhatta Dhar N,et al.The template of the primary lymphatic landing sites of the prostate should be revisited:results of a multimodality mapping study[J].Eur Urol,2008,53(1):118-125.
[23]Kim KH,Rha KH.Re:Steven Joniau,Laura Van den Bergh,Evelyne Lerut,et al.Mapping of pelvic lymph node metastases in prostate cancer.Eur Urol 2013;63:450-8[J].Eur Urol,2013,64(3):e55-e56.doi:10.1016/j.eururo.2013.05.038.
[24]Moschini M,Fossati N,Abdollah F,et al.Determinants of long-term survival of patients with locally advanced prostate cancer:the role of extensive pelvic lymph node dissection[J].Prostate Cancer Prostatic Dis,2016,19(1):63-67.
[25]Pang C,Guan YY,Li HB,et al.Urologic cancer in China[J].Jpn J Clin Oncol,2016,46(6):497-501.
[26]Yao XD,Liu XJ,Zhang SL,et al.Perioperative complications of radical retropubic prostatectomy in patients with locally advanced prostate cancer:a comparison with clinically localized prostate cancer[J].Asian J Androl,2013,15(2):241-245.
[27]Gandaglia G,De Lorenzis E,Novara G,et al.Robotassisted radical prostatectomy and extended pelvic lymph node dissection in patients with locally-advanced prostate cancer[J].Eur Urol,2017,71(2):249-256.
[28]潘家骅,迟辰斐,董柏君,等.多西他赛联合全雄阻断新辅助疗法治疗高危局部进展性前列腺癌的安全性[J].上海交通大学学报(医学版),2017,37(6):797-802.PAN Jiahua,CHI Chenfei,DONG Baijun,et al.Safety of neoadjuvant chemo-hormonal therapy by the combination of docetaxel and maximal androgen blockage for locally advanced prostate cancer[J].Journal of Shanghai Jiaotong University(Medical Science),2017,37(6):797-802.(编辑:相峰)