前列腺癌介绍ppt课件.pptVIP

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1 10,472 patients with localized prostate cancer at Cleveland Clinic and Barnes-Jewish Hospital. radical prostatectomy (N=6493) EBRT (N=2260) brachytherapy (N=1719) 285 OVERALL AND CANCER SPECIFIC URVIVAL FOLLOWING DEFINITIVE THERAPY FOR CLINICALLY LOCALIZED PROSTATE CANCER IN THE PROSTATE-SPECIFIC ANTIGEN ERA 问题1 EBRT and brachytherapy were significantly associated with diminished survival (HR 1.6 [95% CI: 1.4-1.9] and 1.7 [95% CI: 1.4-2.1], respectively; P 0.001)compared to radical prostatectomy after adjusting for biopsy Gleason score, PSA, age, comorbidity, ethnicity, and clinical stage. 问题1 EBRT and brachytherapy were also associated with a significantly higher rate of androgen-deprivation therapy (P 0.001). Compared to radical prostatectomy, a trend towards higher cancer-specific mortality was observed for EBRT (adjusted HR 1.6; 95% CI: 1.0-2.6), but not for brachytherapy (adjusted HR 1.1; 95% CI: 0.5, 2.6) 问题2 Pelvic lymph node dissection (PLND) during radical prostatectomy (RP) provides accurate staging and may be therapeutic, since 10-20% of men with LN metastases (+LN) live 10 years with an undetectable PSA after RP+PLND alone. However, the extent of PLND remains controversial. 1949 LYMPH NODE YIELD USING THE STANDARD LYMPH NODE DISSECTION DURING RADICAL PROSTATECTOMY 问题2 Using a full PLND (external iliac, EI; obturator, O; and hypogastric, H), Studer reported that only 37% of patients with +LN would be identified if PLND was restricted to the EI area above the obturator nerve (the typical limited PLND performed in the US). 问题2 Over a 6 year period a single surgeon (PTS) submitted the PLN as separate packets during open RP in a consecutive series of 613 patients who received no prior therapy for prostate cancer. A full PLND was performed as described above. 问题2 Thirty-five patients had +LN (