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目的探讨早期(T1~2N0M0)前列腺癌患者根治性手术或根治性放疗疗效对比及影响生化复发的相关因素。方法回顾性分析新疆医科大学附属第一临床学院2004年4月至2012年4月间收治的269例早期前列腺癌根治术后患者的临床资料,采用多因素Logistic回归模型分析前列腺癌生化复发的危险因素。结果 269例前列腺癌患者中有97例经随访检测发生前列腺特异性抗原PSA(prostate specific antigen)升高。单因素分析显示,肿瘤分期、Gleason评分、治疗前PSA水平、治疗前血红蛋白(hemoglobin,HGB)、肥胖与前列腺癌生化复发有关(P均<0.05);多因素分析显示,肿瘤分期、Gleason评分、治疗前PSA水平、肥胖是前列腺癌患者生化复发的独立高危因素(P均<0.05)。两种不同的根治性治疗方式的生化复发率比较,总体累积生化复发率为36.0%,其中根治术组累积生化复发率为36.5%(23/63),根治放疗组为36.0%(74/206),两组生化复发的趋势较为一致。两种根治性治疗方式,治疗后第2年及第5年生化复发机率会增高。结论 T分期≥T2a、Gleason评分≥7分、治疗前PSA≥10 ng/ml、肥胖的前列腺癌患者治疗后生化复发风险较高。对早期前列腺癌行根治性手术或根治性放疗可以达到相似的治疗效果,故可以根据患者的身体状况和意愿进行选择。
Objective To investigate the curative effect of radical surgery or radical radiotherapy on early (T1 ~ 2N0M0) prostate cancer patients and the related factors that affect the biochemical relapse. Methods The clinical data of 269 patients with radical prostatectomy who were treated at the First Affiliated Hospital of Xinjiang Medical University from April 2004 to April 2012 were analyzed retrospectively. The risk of biochemical recurrence of prostate cancer was analyzed by multivariate Logistic regression model factor. Results Of the 269 cases of prostate cancer, 97 cases had prostate specific antigen (PSA) elevated after follow-up. Univariate analysis showed that tumor stage, Gleason score, pre-treatment PSA level, pre-treatment hemoglobin (HGB), obesity were associated with biochemical recurrence of prostate cancer (all P <0.05). Multivariate analysis showed that tumor stage, Gleason score, Pre-treatment PSA levels and obesity are independent risk factors for biochemical recurrence in patients with prostate cancer (all P <0.05). The biochemical recurrence rates of the two different radical treatment modalities were 36.0%, 36.5% (23/63) in the radical surgery group and 36.0% (74/206) in the radical radiotherapy group ), Two groups of biochemical recurrence trend is more consistent. Two kinds of radical treatment, the second and fifth years after treatment, the chance of biochemical recurrence will be increased. Conclusion T stage ≥ T2a, Gleason score ≥ 7 points, PSA≥10 ng / ml before treatment, obese prostate cancer patients have a higher risk of biochemical recurrence after treatment. Radical surgery for radical prostatectomy or radical radiotherapy for early prostate cancer can achieve similar therapeutic effects, so patients can choose according to their physical condition and willingness.