CAJ | 학술논문

目的探讨早期前列腺癌近距离照射治疗后影响生化复发率的相关因素. 方法回顾性分析2003年12月至2007年12月117例完成近距离照射治疗的早期前列腺癌患者资料.年龄51～84岁,平均73岁;PSA 0.4～47.6μg/L,＜20.0 μg/L者75例,≥20.0 μg/L者42例;临床分期T1b～T2c;前列腺体积13～69 ml,平均31 ml;穿刺活检阳性率8％～ 100％,＜50％者69例,≥50％者48例;放射剂量D90为106～ 170 Gy,6例联合使用外放疗.采用SPSS 19.0软件观察无生化复发率与患者危险分级、PSA值、Gleason评分、临床分期、前列腺体积、活检阳性率和D90的关系. 结果随访19～114个月,中位时间82个月,平均84个月.33例出现生化复发.低危、中危及高危组的无生化复发率分别为86％、79％及64％,组间比较差异有统计学意义(P=0.040).PSA＜ 20.0μg/L组的无生化复发率高于PSA≥20.0 μg/L组(P=0.028),穿刺阳性率＜50％者高于穿刺阳性率≥50％者(P=0.006),D90≥140 Gy者高于D90＜140 Gy者(P=0.009),组间比较差异均有统计学意义. 结论前列腺癌近距离照射治疗的远期疗效肯定.生化复发和危险分级有关.PSA≥20.0 μg/L、穿刺阳性率≥50％及D90＜140 Gy者生化复发率显著升高.
목적 탐토조기전렬선암근거리조사치료후영향생화복발솔적상관인소. 방법 회고성분석2003년12월지2007년12월117례완성근거리조사치료적조기전렬선암환자자료.년령51～84세,평균73세;PSA 0.4～47.6μg/L,＜20.0 μg/L자75례,≥20.0 μg/L자42례;림상분기T1b～T2c;전렬선체적13～69 ml,평균31 ml;천자활검양성솔8％～ 100％,＜50％자69례,≥50％자48례;방사제량D90위106～ 170 Gy,6례연합사용외방료.채용SPSS 19.0연건관찰무생화복발솔여환자위험분급、PSA치、Gleason평분、림상분기、전렬선체적、활검양성솔화D90적관계. 결과 수방19～114개월,중위시간82개월,평균84개월.33례출현생화복발.저위、중위급고위조적무생화복발솔분별위86％、79％급64％,조간비교차이유통계학의의(P=0.040).PSA＜ 20.0μg/L조적무생화복발솔고우PSA≥20.0 μg/L조(P=0.028),천자양성솔＜50％자고우천자양성솔≥50％자(P=0.006),D90≥140 Gy자고우D90＜140 Gy자(P=0.009),조간비교차이균유통계학의의. 결론 전렬선암근거리조사치료적원기료효긍정.생화복발화위험분급유관.PSA≥20.0 μg/L、천자양성솔≥50％급D90＜140 Gy자생화복발솔현저승고.
Objective To investigate the prognostic factors of biochemical relapse in patients with early stage prostate cancer after brachytherapy.Methods From December 2003 to December 2007,117 patients (age 51-84 years,median 73 years) with early stage prostate cancer underwent brachytherapy at our hospital.The PSA ranged from 0.4 to 47.6 μg/L (median,14.7 g/L),in which 75 cases with PSA＜ 20.0 μg/L and 42 cases with PSA≥20.0 μg/L.Clinical stage ranged from T1b to T2c.The prostate volume ranged from 13 to 69 ml (average,31 ml),and the percentage of positive biopsy cores was 8％ to 100％ (average,45％),in which 69 cases with a positivity＜50％ and 48 cases with a positivity≥50％.The D90 ranged from 106 to 170 Gy (average,142 Gy).And 6 patients were treated with external beam radiation in combination.The biochemical no evidence of disease (bNED) rate was recorded.And possible prognostic factors,including risk stratification,PSA,clinical stage,prostate volume,biopsy positivity and D90,were analyzed by using SPSS 19.0 software.Results The patients were followed up for 19 to 114 months (average,84 months; median,82 months).And biochemical relapse was observed in 33 cases (bNED rate,72％).The bNED rates in low-risk,intermediate-risk and high-risk groups were 86％,79％ and 64％,respectively and significant correlations were found between bNED rate and risk stratification (P=0.040).Moreover,the bNED rate was significantly higher in patients with the following factors,namely PSA＜20.0 μg/L (P =0.028),percentage of positive biopsy cores＜50％ (P =0.006) and high-dose implants (D90 ≥ 140 Gy) (P=0.009).Conclusions The long-term efficacy of brachytherapy in early stage prostate cancer is definite.Significant associations are found between bNED rate and risk stratification.And higher rates of biochemical relapse could be found in patients with PSA ≥ 20.0 μg/L,percentage of positive biopsy cores ≥ 50％ or D90＜ 140 Gy groups.