前列腺导管内癌48例治疗经验及预后分析：一项单中心回顾性研究

Clinical experience and prognosis analysis of 48 cases of intraductal carcinoma of the prostate: a single-center retrospective study

摘要

目的 分析总结前列腺导管内癌（IDC-P）的临床特点和治疗经验，提高临床对IDC-P的诊疗水平。方法 回顾性分析2017年5月-2024年3月于首都医科大学附属北京友谊医院泌尿外科收治的48例IDC-P患者的临床资料。确诊（病理标本获得）方式：27例经前列腺穿刺活检术，2例经尿道前列腺等离子电切术，19例经前列腺癌根治术。治疗方式：24例行前列腺癌根治术，21例直接行内分泌治疗，2例行前列腺放射性¹²⁵I粒子植入术+雄激素剥夺治疗，1例观察等待。采用Kaplan-Meier法对主要观察指标进行单因素生存分析。结果 1例患者失访，随访成功的47例患者中24例行前列腺癌根治术，22例术后行内分泌治疗，10例发生生化复发；23例未行前列腺癌根治术直接行内分泌治疗，14例发生生化复发。共45例患者行内分泌治疗，标准内分泌治疗33例，21例发生生化复发；新型内分泌治疗12例，3例发生生化复发。生存分析提示是否行前列腺癌根治术对内分泌治疗后发生生化复发并无显著影响（P=0.250）；采用新型内分泌治疗较标准内分泌治疗可延缓患者生化复发（P=0.003）。结论 采用阿比特龙或恩扎卢胺等新型内分泌方法治疗IDC-P可降低患者的生化复发风险，但尚需进一步研究来确定最佳治疗方案。

Abstract

Objective To analyze and summarize the clinical characteristics and treatment methods of intraductal carcinoma of the prostate (IDC-P), so as to improve the diagnosis and treatment of this disease. Methods The clinical data of 48 IDC-P patients treated in Beijing Friendship Hospital during May 2017 and Mar. 2024 were retrospectively analyzed. IDC-P was diagnosed by pathology in 27 cases by prostate puncture, in 2 cases by transurethral plasma resection of the prostate, and in 19 cases by radical prostatectomy. Of all patients, 24 received radical prostatectomy, 21 received direct endocrinotherapy, 2 received prostate radioactive¹²⁵I implantation brachytherapy combine with androgen deprivation therapy, and 1 patient was observed and waiting. Kaplan-Meier method was used to analyze the main prognostic indicators. Results One patient was lost to follow-up. Of the 47 patients followed up, 24 underwent radical prostatectomy, of whom 22 underwent postoperative endocrinotherapy, and 10 had biochemical recurrence; 23 patients only received endocrinotherapy, and 14 of them had biochemical recurrence. Altogether 45 patients received endocrinotherapy, including 33 who received standardized treatment (21 had biochemical recurrence) and 12 who received novel treatment (3 had biochemical recurrence). Survival analysis showed that radical prostatectomy had no significant impact on the biochemical recurrence after endocrinotherapy (P=0.250). Novel endocrinotherapy could delay biochemical recurrence compared with standardized endocrinotherapy (P=0.003). Conclusion Abiraterone or enzalutamide therapy can reduce the risk of biochemical recurrence, but further studies are needed to determine the optimal treatment for IDC-P patients.

关键词

前列腺导管内癌 / 前列腺癌根治术 / 内分泌治疗 / 生化复发

Key words

intraductal carcinoma of the prostate / radical prostatectomy / endocrinotherapy / biochemical recurrence

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