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目的分析合并膀胱出口梗阻的前列腺癌患者行经尿道前列腺电切术后的生存状况并探讨其影响因素。方法回顾性收集2008~2015年于首都医科大学附属北京友谊医院行经尿道前列腺电切术的前列腺癌患者的病例资料并分析其生存状况,以肿瘤特异性死亡率及无失败生存期为主要研究终点,绘制生存曲线并采用Cox回归模型对其影响因素进行分析。结果共108例前列腺癌患者行经尿道前列腺电切术,包括92例术前已诊断前列腺癌患者及16例偶发前列腺癌患者。所有患者的中位年龄74岁,中位前列腺特异性抗原水平24.3 ng/ml,中位前列腺体积为54.9ml。中位随访65.5个月后,已诊断组的肿瘤特异性死亡率为60.9%(56/92),肿瘤特异性生存期为55个月。已诊断组及偶发组的无失败生存期分别为38个月及39个月。已诊断组的肿瘤特异性死亡率影响因素分别为Gleason评分(P=0.02)、临床分期(P=0.04)及远处转移(P=0.004),无失败生存期影响因素为临床分期(P=0.03)、远处转移(P=0.004)。偶发组的无失败生存期影响因素为年龄(P=0.03)及远处转移(P=0.004)。结论合并膀胱出口梗阻的前列腺癌患者原发肿瘤的相关特征会影响经尿道前列腺电切术后的肿瘤特异性死亡率。局部高危前列腺癌或远处转移前列腺癌患者的无失败生存期较短。对于偶发癌,年龄及Gleason评分为无失败生存期的独立预测因素。
Objective To analyze the survival status of prostate cancer patients with bladder outlet obstruction and its influencing factors after transurethral resection of the prostate. Methods The data of patients with prostate cancer who underwent transurethral resection of prostate in Beijing Friendship Hospital, Capital Medical University from 2008 to 2015 were retrospectively collected and their survival was analyzed. Tumor-specific mortality and failure-free survival were taken as the primary study endpoints The survival curves were drawn and the influencing factors were analyzed by Cox regression model. Results A total of 108 cases of prostate cancer underwent transurethral resection of the prostate, including 92 cases of preoperatively diagnosed prostate cancer and 16 cases of incidental prostate cancer. All patients had a median age of 74 years, a median prostate-specific antigen level of 24.3 ng / ml, and a median prostate volume of 54.9 ml. After a median follow-up of 65.5 months, the tumor-specific mortality in the diagnosed group was 60.9% (56/92) and the tumor-specific survival was 55 months. The failure-free survival of the diagnosed and occasional groups was 38 months and 39 months respectively. The tumor-specific mortality rates in the diagnosed group were Gleason score (P = 0.02), clinical stage (P = 0.04) and distant metastasis (P = 0.004), respectively. The influencing factors of failure-free survival were clinical stage 0.03), distant metastasis (P = 0.004). Incidence of failure-free survival of patients with age-related factors (P = 0.03) and distant metastasis (P = 0.004). Conclusions The characteristics of the primary tumor in prostate cancer patients with bladder outlet obstruction affect the tumor-specific mortality after transurethral resection of the prostate. Local high-risk prostate cancer or distant metastasis of prostate cancer patients with short survival-free. For incidental cancers, the age and Gleason score were independent predictors of failure-free survival.