前列腺導(dǎo)管內(nèi)癌48例治療經(jīng)驗(yàn)及預(yù)后分析：一項(xiàng)單中心回顧性研究

ABSTRACT：ObjectiveTo 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.MethodsThe 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 receivedprostate radioactive 125I 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.ResultsOne 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 hadbiochemical 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.

摘要：

目的分析總結(jié)前列腺導(dǎo)管內(nèi)癌（IDC-P）的臨床特點(diǎn)和治療經(jīng)驗(yàn)，提高臨床對(duì)IDC-P的診療水平。方法回顧性分析2017年5月—2024年3月于首都醫(yī)科大學(xué)附屬北京友誼醫(yī)院泌尿外科收治的48例IDC-P患者的臨床資料。確診（病理標(biāo)本獲得）方式：27例經(jīng)前列腺穿刺活檢術(shù)，2例經(jīng)尿道前列腺等離子電切術(shù)，19例經(jīng)前列腺癌根治術(shù)。治療方式：24例行前列腺癌根治術(shù)，21例直接行內(nèi)分泌治療，2例行前列腺放射性125I粒子植入術(shù)+雄激素剝奪治療，1例觀察等待。采用Kaplan-Meier法對(duì)主要觀察指標(biāo)進(jìn)行單因素生存分析。結(jié)果1例患者失訪，隨訪成功的47例患者中24例行前列腺癌根治術(shù)，22例術(shù)后行內(nèi)分泌治療，10例發(fā)生生化復(fù)發(fā)；23例未行前列腺癌根治術(shù)直接行內(nèi)分泌治療，14例發(fā)生生化復(fù)發(fā)。共45例患者行內(nèi)分泌治療，標(biāo)準(zhǔn)內(nèi)分泌治療33例，21例發(fā)生生化復(fù)發(fā)；新型內(nèi)分泌治療12例，3例發(fā)生生化復(fù)發(fā)。生存分析提示是否行前列腺癌根治術(shù)對(duì)內(nèi)分泌治療后發(fā)生生化復(fù)發(fā)并無顯著影響（P=0.250）；采用新型內(nèi)分泌治療較標(biāo)準(zhǔn)內(nèi)分泌治療可延緩患者生化復(fù)發(fā)（P=0.003）。結(jié)論采用阿比特龍或恩扎盧胺等新型內(nèi)分泌方法治療IDC-P可降低患者的生化復(fù)發(fā)風(fēng)險(xiǎn)，但尚需進(jìn)一步研究來確定最佳治療方案。

關(guān)鍵詞：前列腺導(dǎo)管內(nèi)癌；前列腺癌根治術(shù)；內(nèi)分泌治療；生化復(fù)發(fā)

中圖分類號(hào)：R737.25" " " " " " " 文獻(xiàn)標(biāo)志碼：A" " " " " " " " DOI：10.3969/j.issn.1009-8291.2025.03.008

前列腺導(dǎo)管內(nèi)癌（intraductal carcinoma of prostate，IDC-P）在2016年世界衛(wèi)生組織（World Health Organization，WHO）病理分類中首次被劃分為前列腺癌的一種獨(dú)立病理實(shí)體[1]。IDC-P相對(duì)較少見[2]，但現(xiàn)有臨床證據(jù)表明無論是在局限性前列腺癌還是晚期前列腺癌階段，IDC-P的檢出均與患者的不良預(yù)后密切相關(guān)[3]。……