摘要目的 研究近距离照射治疗局限性前列腺癌的效果及其影响因素.方法 回顾性分析2001年4月至2011年3月于北京大学第一医院泌尿外科接受近距离照射治疗的61例局限性前列腺癌患者资料,其中联合外放疗11例.患者年龄57～84岁,平均75.2岁.肿瘤临床分期:T1c 12例,T2a 18例,T2b 17例,T2c 14例.Gleason评分平均7分(范围5～9分).随访术后前列腺特异抗原(PSA)变化及不良反应发生情况,绘制Kaplan-Meier生化无复发生存曲线,并以单因素Cox回归分析和Log-rank检验分析治疗效果的影响因素.结果 61例患者获得随访,随访时间9～126个月,中位随访时间49个月.术前PSA平均为(17.80±14.44) μg/L,术后PSA最低值平均为(1.16±1.15) μg/L.58例(95.1％)患者最低PSA＜4.0μg/L,37例(60.7％)患者最低PSA＜1.0μg/L,达最低PSA时间平均为术后11.6个月,术后短期不良反应少见(发热、血尿、便血等),长期不良反应主要为尿路刺激症状.近距离照射治疗后平均生化无复发生存时间的估计值为41.0个月.接受联合外放疗的11例患者治疗后PSA最低值平均为1.32 μg/L,平均生化无复发生存时间为38个月.PSA所达最低值是否＜1.0μg/L对生化无复发生存时间有显著影响(x2=4.445,P=0.035).结论 近距离照射治疗对局限性前列腺癌疗效肯定,严重不良反应少见;治疗后PSA最低值是否＜1.0μg/L有助于判断预后.

abstractsObjective To investigate the efficacy of brachytherapy for patients with localized prostate cancer and the influence factors.Methods There were 61 patients with localized prostate cancer were treated with brachytherapy between April 2001 and March 2011 in Department of Urology,Peking University First Hospital,including 11 patients who received combined external beam radiotherapy.The mean age was 75.2 years (range 57-84 years).Clinical stage was T1c in 12 patients,T2a in 18 patients,T2b in 17 patients,and T2c in 14 patients.Long-term follow-up was carried on all patients for prostate specific antigen(PSA) and adverse effects.Kaplan-Meier survival curves,Log-rank test and univariate Cox proportional hazard regression analysis was used to examine the factors associated with the treatment efficacy.Results The median follow-up was 49 months(range 9-126 months).The mean PSA before treatment andthe mean nadir PSA after operation were(17.80 ± 14.44) μg/L and (1.16 ± 1.15)μg/L,respectively.The PSA of 58 patients (95.1％) reached a nadir ＜ 4.0μg/L,which was even ＜ 1.0μg/L in 37 patients (60.7％).The mean time to reach the nadir PSA was 11.6 months after operation.The short-term adverse events after operation included fever in 4 patients,hematuria in 7 patients,and hematochezia in 4 patients.The most common long-term adverse event was urinary irritation (31.1％);other long-term adverse events were rare,including hematochezia,hematuria,urinary incontinence,urinary retention,mild diarrhea and radiation enteritis.The estimated mean biochemical recurrence-free survival after brachytherapy was 41.0 months (95％ CI:31.05-50.94 months).The mean nadir PSA after operation were 1.32 μg/L in the 11 patients who received combined external beam radiotherapy,and their estimated mean biochemical recurrence-free survival was 38 months.Patients with nadir PSA ＜ 1.0 μg/L had a significant longer biochemical recurrence-free survival than those with nadir PSA between 1.0μg/L and 4.0μg/L (42.9 vs.32.0 months,x2 =4.445,P=0.035).Conclusions Brachytherapy is an effective treatment strategy for localized prostate cancer,with relatively low rate of severe adverse events.After brachytherapy,a nadir PSA ＜ 1.0μg/L might indicate a better prognosis.