晚期前列腺癌伴膀胱出口梗阻TURP或α1A受体阻滞剂联合内分泌治疗的疗效分析
|
摘要
目的:比较经尿道前列腺电切术(TURP)联合内分泌治疗与α1A受体阻滞剂联合内分泌治疗晚期前列腺癌伴膀胱出口梗阻的疗效,并探讨TURP联合内分泌治疗晚期前列腺癌伴膀胱出口梗阻的安全性。方法:回顾性分析2009年1月至2013年1月采用α1A受体阻滞剂联合内分泌治疗或TURP联合内分泌治疗晚期前列腺癌伴膀胱出口梗阻患者63例,其中28例行α1A受体阻滞剂联合内分泌治疗,35例行TURP联合内分泌治疗。比较两组患者治疗前后的残余尿量(RV)、最大尿流率(Qmax)、国际前列腺症状评分(IPSS)、生活质量评分(Qo L)及总体生存率。结果:TURP联合内分泌治疗组术后3个月RV、IPSS、Qo L分别由术前的(137.8±27.6)ml、(22.3±3.6)分、(4.2±0.8)分降至(29.0±13.6)ml、(7.8±2.1)分、(1.6±0.5)分(P均<0.05),Qmax由术前的(5.6±2.1)ml/s增至(17.6±2.7)ml/s(P<0.05)。α1A受体阻滞剂联合内分泌治疗组术后3个月RV、IPSS、Qo L分别由术前的(133.6±24.9)ml、(21.5±3.2)分、(4.7±1.1)分降至(42.0±18.3)ml、(12.8±2.6)分、(2.5±0.7)分(P均<0.05),Qmax由术前的(6.3±2.4)ml/s增至(11.7±2.3)ml/s(P<0.05)。治疗3个月后两组相比,RV、IPSS、Qo L及Qmax之间的差异均具有统计学意义(P均<0.05)。α1A受体阻滞剂联合内分泌治疗组总体生存率为46.4%,TURP联合内分泌治疗组为51.4%,差异无显著性(P>0.05)。结论:较α1A受体阻滞剂联合内分泌治疗,TURP联合内分泌治疗能显著缓解晚期前列腺癌患者膀胱出口梗阻症状,且不影响总体生存率,是治疗晚期前列腺癌伴膀胱出口梗阻的首选方法。
Objective: To compare the effect of transurethral resection of the prostate combined with endocrine therapy( TURP+ ET) with that of α1A-blockers combined with ET( α1A-b + ET) in the treatment of bladder outlet obstruction( BOO) in patients with advanced prostate cancer( PCa),and to investigate the safety of the TURP + ET for the treatment of PCa with BOO. Methods:We retrospectively analyzed 63 cases of PCa with BOO,28 treated by α1A-b + ET and the other 35 by TURP + ET. We obtained the residual urine volume( RV),maximum urinary flow rate( Qmax),International Prostate Symptom Score( IPSS),and quality of life score( Qo L) before and after treatment along with the overall survival rate of the patients,followed by comparison of the parameters between the two methods. Results: At 3 months after treatment,RV,IPSS,and Qo L in the TURP + ET group were significantly decreased from( 137. 8 ± 27. 6) ml,( 22. 3 ± 3. 6),and( 4. 2 ± 0. 8) to( 29 ± 13. 6) ml,( 7. 8 ± 2. 1),and( 1. 6 ± 0. 5) respectively( P < 0. 05),while Qmax increased from( 5. 6 ± 2. 1) ml/s to( 17. 6 ± 2. 7) ml/s( P < 0. 05); the former three parameters in theα1A-b + ET group decreased from( 133. 6 ± 24. 9) ml,( 21. 5 ± 3. 2),and( 4. 7 ± 1. 1) to( 42 ± 18. 3) ml,( 12. 8 ± 2. 6),and( 2. 5 ± 0. 7) respectively( P < 0. 05),while the latter one increased from( 6. 3 ± 2. 4) ml/s to( 11. 7 ± 2. 3) ml/s( P < 0. 05),all with statistically significant differences between the two groups( P < 0. 05). The overall survival rate of the TURP + ET group was not significantly different from that of the α1A-b + ET group( 51. 4% vs 46. 4%,P > 0. 05). Conclusion: TURP + ET is preferable toα1A-b + ET for its advantage of relieving BOO symptoms in advanced PCa without affecting the overall survival rate of the patients.
Objective: To compare the effect of transurethral resection of the prostate combined with endocrine therapy( TURP+ ET) with that of α1A-blockers combined with ET( α1A-b + ET) in the treatment of bladder outlet obstruction( BOO) in patients with advanced prostate cancer( PCa),and to investigate the safety of the TURP + ET for the treatment of PCa with BOO. Methods:We retrospectively analyzed 63 cases of PCa with BOO,28 treated by α1A-b + ET and the other 35 by TURP + ET. We obtained the residual urine volume( RV),maximum urinary flow rate( Qmax),International Prostate Symptom Score( IPSS),and quality of life score( Qo L) before and after treatment along with the overall survival rate of the patients,followed by comparison of the parameters between the two methods. Results: At 3 months after treatment,RV,IPSS,and Qo L in the TURP + ET group were significantly decreased from( 137. 8 ± 27. 6) ml,( 22. 3 ± 3. 6),and( 4. 2 ± 0. 8) to( 29 ± 13. 6) ml,( 7. 8 ± 2. 1),and( 1. 6 ± 0. 5) respectively( P < 0. 05),while Qmax increased from( 5. 6 ± 2. 1) ml/s to( 17. 6 ± 2. 7) ml/s( P < 0. 05); the former three parameters in theα1A-b + ET group decreased from( 133. 6 ± 24. 9) ml,( 21. 5 ± 3. 2),and( 4. 7 ± 1. 1) to( 42 ± 18. 3) ml,( 12. 8 ± 2. 6),and( 2. 5 ± 0. 7) respectively( P < 0. 05),while the latter one increased from( 6. 3 ± 2. 4) ml/s to( 11. 7 ± 2. 3) ml/s( P < 0. 05),all with statistically significant differences between the two groups( P < 0. 05). The overall survival rate of the TURP + ET group was not significantly different from that of the α1A-b + ET group( 51. 4% vs 46. 4%,P > 0. 05). Conclusion: TURP + ET is preferable toα1A-b + ET for its advantage of relieving BOO symptoms in advanced PCa without affecting the overall survival rate of the patients.
引文
[1]王凯,李晓军,印洪林,等.ID3蛋白在前列腺癌中的表达及临床病理学意义.中华男科学杂志,2011,17(5):410-413.
[2]杨关天,姚茂银,杨建军,等.TUVP联合TURP治疗合并膀胱出口梗阻的前列腺癌.中华男科学杂志,2005,11(7):523-525.
[3]俞弘颀,赵雪志,陈齐峰,等.TURP结合抗雄激素干预治疗中晚期前列腺癌36例.暨南大学学报(医学版),2009,30(6):678-680.
[4]Crain DS,Amling CL,Kane CJ.Palliative transurethral prostate resection for bladder outlet obstruction in patients with locally advanced prostate cancer.J Urol,2004,171(2 Pt 1):668-671.
[5]叶敏,朱英坚,王伟明,等.经尿道汽化切除治疗伴膀胱出口梗阻的晚期前列腺癌.中华泌尿外科杂志,2007,28(8):544-547.
[6]汪自力,易炜,陈刚,等.经尿道等离子电切联合内分泌治疗晚期前列腺癌导致下尿路梗阻的临床疗效.中华腔镜泌尿外科杂志(电子版),2011,5(3):222-224.
[7]王强,王军起,管同郁,等.合并膀胱出口梗阻的晚期前列腺癌的治疗.中华男科学杂志,2013,19(2):184-185.
[8]张浩斌,金成东.隧道式TURP治疗伴膀胱出口梗阻的晚期前列腺癌.中国临床研究,2010,23(5):384-385.
[9]Ito K,Ohtani H,Sawada Y.Assessment of alpha1-adrenoceptorantagonists in benign prostatic hyperplasia based on the receptor occupancy theory.Br J Clin Pharmacol,2007,63(4):394-403.
[10]Heung YM,Walsh K,Sriprasad S,et al.The detection of prostate cells by the reverse transcription-polymerase chain reaction in the circulation of patients undergoing transurethral resection of the prostate.BJU Int,2000,85(1):65-69.
[11]Forman JD,Order SE,Zinreich ES,et al.The correlation of pretreatment transurethral resection of prostatic cancer of with tumor dissemmination and disease-free survival.A univariate and multivafiate analysis.Cancer,1986,58(8):1770-1778.
[12]Krupski TL,Stukenborg GJ,Mook K,et al.The relationship of palliative transurethral resection of prostate with disease progression in patients with prostate cancer.BJU Int,2010,106(10):1477-1483.
[13]Fowler JE Jr,Fisher HA,Kaiser DL,et al.Relationship of pretreatment transurethral resection of prostate to survival with distant metastases in patients treated with 125I-implantation for localized prostatic cancer.Cancer,1984,53(9):1857-1863.
[14]Marszalek M,Ponholzer A,Rauchenwald M,et al.Palliative transurethral resection of the prostate:Functional outcome and impact on survival.BJU Int,2007,99(1):56-59.
[15]Kuban DA,el-Mahdi AM,Schellhammer PF,et al.The effect of transurethral prostatic resection on the incidence of osseous prostatic metastasis.Cancer,1985,56(4):961-964.
[2]杨关天,姚茂银,杨建军,等.TUVP联合TURP治疗合并膀胱出口梗阻的前列腺癌.中华男科学杂志,2005,11(7):523-525.
[3]俞弘颀,赵雪志,陈齐峰,等.TURP结合抗雄激素干预治疗中晚期前列腺癌36例.暨南大学学报(医学版),2009,30(6):678-680.
[4]Crain DS,Amling CL,Kane CJ.Palliative transurethral prostate resection for bladder outlet obstruction in patients with locally advanced prostate cancer.J Urol,2004,171(2 Pt 1):668-671.
[5]叶敏,朱英坚,王伟明,等.经尿道汽化切除治疗伴膀胱出口梗阻的晚期前列腺癌.中华泌尿外科杂志,2007,28(8):544-547.
[6]汪自力,易炜,陈刚,等.经尿道等离子电切联合内分泌治疗晚期前列腺癌导致下尿路梗阻的临床疗效.中华腔镜泌尿外科杂志(电子版),2011,5(3):222-224.
[7]王强,王军起,管同郁,等.合并膀胱出口梗阻的晚期前列腺癌的治疗.中华男科学杂志,2013,19(2):184-185.
[8]张浩斌,金成东.隧道式TURP治疗伴膀胱出口梗阻的晚期前列腺癌.中国临床研究,2010,23(5):384-385.
[9]Ito K,Ohtani H,Sawada Y.Assessment of alpha1-adrenoceptorantagonists in benign prostatic hyperplasia based on the receptor occupancy theory.Br J Clin Pharmacol,2007,63(4):394-403.
[10]Heung YM,Walsh K,Sriprasad S,et al.The detection of prostate cells by the reverse transcription-polymerase chain reaction in the circulation of patients undergoing transurethral resection of the prostate.BJU Int,2000,85(1):65-69.
[11]Forman JD,Order SE,Zinreich ES,et al.The correlation of pretreatment transurethral resection of prostatic cancer of with tumor dissemmination and disease-free survival.A univariate and multivafiate analysis.Cancer,1986,58(8):1770-1778.
[12]Krupski TL,Stukenborg GJ,Mook K,et al.The relationship of palliative transurethral resection of prostate with disease progression in patients with prostate cancer.BJU Int,2010,106(10):1477-1483.
[13]Fowler JE Jr,Fisher HA,Kaiser DL,et al.Relationship of pretreatment transurethral resection of prostate to survival with distant metastases in patients treated with 125I-implantation for localized prostatic cancer.Cancer,1984,53(9):1857-1863.
[14]Marszalek M,Ponholzer A,Rauchenwald M,et al.Palliative transurethral resection of the prostate:Functional outcome and impact on survival.BJU Int,2007,99(1):56-59.
[15]Kuban DA,el-Mahdi AM,Schellhammer PF,et al.The effect of transurethral prostatic resection on the incidence of osseous prostatic metastasis.Cancer,1985,56(4):961-964.