局灶射频消融治疗低危与中危局限性前列腺癌的疗效分析

Efficacy of focal radiofrequency ablation in the treatment of low-to-intermediate risk localized prostate cancer

摘要

目的 探讨局灶射频消融（RFA）治疗低危与中危局限性前列腺癌的疗效及其对患者术后尿控和性功能恢复的影响，以期探究微创方法治疗局限性前列腺癌的可行性。方法 回顾性分析2017年6月-2021年2月南京大学医学院附属鼓楼医院接受RFA治疗的28例低危与中危局限性前列腺癌患者的临床资料，统计分析患者的5年无失败生存（FFS）率、手术相关并发症、术后尿控及性功能情况。采用log-rank检验和Breslow检验评估低危与中危分组患者生存曲线间的差异。结果 所有手术均在局部麻醉下顺利完成。中位随访时间43（40～49）个月，随访期内所有患者均存活，采用Kaplan-Meier法预测的5年FFS率为78.57%。25例（89.29%）患者未出现手术相关并发症，27例（96.43%）患者术后可以自主控尿。1例患者术后出现新发性功能障碍。低危组与中危组患者间生存曲线差异无统计学意义（P＞0.05）。结论 局灶RFA治疗低危与中危局限性前列腺癌患者临床疗效较好，对尿控及性功能的影响小且术后并发症较少，是该类患者的可选治疗方案。

Abstract

Objective To explore the efficacy of focal radiofrequency ablation (RFA) in the treatment of low-to-intermediate risk localized prostate cancer and its impact on postoperative urinary control and sexual function recovery, in order to explore the feasibility of minimally invasive methods for the treatment of localized prostate cancer. Methods Clinical data of 28 patients with low-to-intermediate risk localized prostate cancer who underwent RFA in Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School during Jun. 2017 and Feb. 2021 were retrospectively analyzed. The 5-year failure-free survival (FFS) rate, surgery related complications, postoperative urinary control and sexual function were collected. The differences between the survival curves of patients in the low-risk and intermediate-risk subgroups were assessed with log-rank test and Breslow test. Results All surgeries were successfully completed under local anesthesia. During the median follow-up of 43 (40-49) months, the 5-year FFS rate predicted by Kaplan-Meier method was 78.57%; 25 patients (89.29%) did not experience surgery-related complications; 27 patients (96.43%) were able to control urination; 1 patient developed new-onset sexual dysfunction. There was no significant difference in the survival curves between patients in the low-risk and intermediate-risk groups (P>0.05). Conclusion RFA for patients with low-to-intermediate risk localized prostate cancer has good clinical efficacy, little impact on urinary control and sexual function recovery, and few postoperative complications, which can be used as one of the treatment options for these patients.

关键词

局灶射频消融 / 前列腺癌 / 低危与中危 / 局限性 / 无失败生存率 / 尿控 / 性功能

Key words

focal radiofrequency ablation / prostate cancer / low-to-intermediate risk / localized / failure-free survival rate / urinary control / sexual function

参考文献

[1] SUNG H, FERLAY J, SIEGEL RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.

[2] AYDIN AM, GAGE K, DHILLON J, et al. Focal bipolar radiofrequency ablation for localized prostate cancer: safety and feasibility[J]. Int J Urol, 2020, 27(10): 882-889.

[3] 张梦洁, 张青, 郭宏骞. 前列腺癌局灶治疗的新进展[J]. 现代泌尿外科杂志, 2023, 28(1): 83-88, 90.

[4] 黄健, 张旭, 魏强, 等. 中国泌尿外科和男科疾病诊断治疗指南(2022版)[M]. 北京: 科学出版社, 2022: 141-143.

[5] LEBASTCHI AH, GEORGE AK, POLASCIK TJ, et al. Standardized nomenclature and surveillance methodologies after focal therapy and partial gland ablation for localized prostate cancer: an international multidisciplinary consensus[J]. Eur Urol, 2020, 78(3): 371-378.

[6] TOURINHO-BARBOSA RR, SANCHEZ-SALAS R, CLAROS OR, et al. Focal therapy for localized prostate cancer with either high intensity focused ultrasound or cryoablation: a single institution experience[J]. J Urol, 2020, 203(2): 320-330.

[7] WALSER E, NANCE A, YNALVEZ L, et al. Focal laser ablation of prostate cancer: results in 120 patients with low-to intermediate-risk disease[J]. J Vasc Interv Radiol, 2019, 30(3): 401-409.e2.

[8] VAN DEN BOS W, SCHELTEMA MJ, SIRIWARDANA AR, et al. Focal irreversible electroporation as primary treatment for localized prostate cancer[J]. BJU Int, 2018, 121(5): 716-724.

[9] GUILLAUMIE S, PETERS M, ARYA M, et al. A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer[J]. Eur Urol, 2018, 74(4): 422-429.

[10] NICOLETTI R, ALBERTI A, CASTELLANI D, et al. Functional outcomes and safety of focal therapy for prostate cancer: a systematic review on results and patient-reported outcome measures (PROMs)[J]. Prostate Cancer Prostatic Dis, 2024, 27(4): 614-622.

[11] MENON M, DALELA D, JAMIL M, et al. Functional recovery, oncologic outcomes and postoperative complications after robot-assisted radical prostatectomy: an evidence-based analysis comparing the retzius sparing and standard approaches[J]. J Urol, 2018, 199(5): 1210-1217.

[12] HAMDY FC, DONOVAN JL, LANE JA, et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer[J]. New Engl J Med, 2016, 375(15): 1415-1424.

[13] LARDAS M, LIEW M, VAN DEN BERGH RC, et al. Quality of life outcomes after primary treatment for clinically localised prostate cancer: a systematic review[J]. Eur Urol, 2017, 72(6): 869-885.

[14] HOPSTAKEN JS, BOMERS JGR, SEDELAAR MJP, et al. An updated systematic review on focal therapy in localized prostate cancer: what has changed over the past 5 years?[J]. Eur Urol, 2022, 81(1): 5-33.

[15] AHMED HU. The index lesion and the origin of prostate cancer[J]. New Engl J Med, 2009, 361(17): 1704-1706.

[16] RUIJTER ET, VAN DE KAA CA, SCHALKEN JA, et al. Histological grade heterogeneity in multifocal prostate cancer. Biological and clinical implications[J]. J Pathol, 1996, 180(3): 295-299.

[17] ORCZYK C, BARRATT D, BREW-GRAVES C, et al. Prostate radiofrequency focal ablation (ProRAFT) trial: a prospective development study evaluating a bipolar radiofrequency device to treat prostate cancer[J]. J Urol, 2021, 205(4): 1090-1099.

[18] SHAH TT, PETERS M, ELDRED-EVANS D, et al. Early-medium-term outcomes of primary focal cryotherapy to treat nonmetastatic clinically significant prostate cancer from a prospective multicentre registry[J]. Eur Urol, 2019, 76(1): 98-105.

[19] VAN LUIJTELAAR A, GREENWOOD BM, AHMED HU, et al. Focal laser ablation as clinical treatment of prostate cancer: report from a Delphi consensus project[J]. World J Urol, 2019, 37(10): 2147-2153.