AUA前列腺癌介绍.ppt

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1、2010年美国泌尿外科年会前列腺癌相关进展北京大学第三医院泌尿外科刘磊马潞林关于前列腺癌的文献数量多，分类细临床随访数量多，资料翔实涉及的领域比较广泛问题1前列腺癌根治术（RP）、前列腺癌外放射治疗（EBRT）、前列腺癌近距离照射治疗（brachytherapy）这三种方法治疗效果的比较？问题110,472patientswithlocalizedprostatecanceratClevelandClinicandBarnes-JewishHospital.radicalprostatectomy(N=6493)EBRT(N=2260)brachytherapy(N=1

2、719)285OVERALLANDCANCERSPECIFICURVIVALFOLLOWINGDEFINITIVETHERAPYFORCLINICALLYLOCALIZEDPROSTATECANCERINTHEPROSTATE-SPECIFICANTIGENERA问题1EBRTandbrachytherapyweresignificantlyassociatedwithdiminishedsurvival(HR1.6[95%CI:1.4-1.9]and1.7[95%CI:1.4-2.1],respectively;P<0.001)comparedtoradicalpro

3、statectomyafteradjustingforbiopsyGleasonscore,PSA,age,comorbidity,ethnicity,andclinicalstage.问题1EBRTandbrachytherapywerealsoassociatedwithasignificantlyhigherrateofandrogen-deprivationtherapy(P<0.001).Comparedtoradicalprostatectomy,atrendtowardshighercancer-specificmortalitywasobservedfo

4、rEBRT(adjustedHR1.6;95%CI:1.0-2.6),butnotforbrachytherapy(adjustedHR1.1;95%CI:0.5,2.6)问题1Afteradjustingforthemostrelevantdisease-specificandpatient-specificconfounders,radicalprostatectomyisassociatedwithimprovedintermediate-termsurvivalcomparedtoEBRTandbrachytherapy.Physiciansandpatient

5、sshouldconsiderthesepotentialsurvivaldifferenceswhenchoosingamongtreatmentoptionsforlocalizedprostatecancer.问题2前列腺癌淋巴结清扫的范围？问题2Pelviclymphnodedissection(PLND)duringradicalprostatectomy(RP)providesaccuratestagingandmaybetherapeutic,since10-20%ofmenwithLNmetastases(+LN)live>10yearswithanun

6、detectablePSAafterRP+PLNDalone.However,theextentofPLNDremainscontroversial.1949LYMPHNODEYIELDUSINGTHESTANDARDLYMPHNODEDISSECTIONDURINGRADICALPROSTATECTOMY问题2UsingafullPLND(externaliliac,EI;obturator,O;andhypogastric,H),Studerreportedthatonly37%ofpatientswith+LNwouldbeidentifiedifPLNDwasr

7、estrictedtotheEIareaabovetheobturatornerve(thetypicallimitedPLNDperformedintheUS).问题2Overa6yearperiodasinglesurgeon(PTS)submittedthePLNasseparatepacketsduringopenRPinaconsecutiveseriesof613patientswhoreceivednopriortherapyforprostatecancer.AfullPLNDwasperformedasdescribed