【摘要】 目的:分析¹²⁵I粒子植入近距离放疗治疗≤cT3期前列腺癌的临床效果，探讨影响术后无生化复发生存率（biochemical relapse-free survival, bRFS）和总生存率（overall survival, OS）的相关因素。方法:回顾性分析2006年1月—2016年12月于天津医科大学第二医院经¹²⁵I粒子植入放疗的116例≤cT3期前列腺癌患者的临床资料。采用Kaplan-Meier法统计患者术后5、8年的bRFS、OS;分别采用Log-rank法和Cox比例风险模型评估穿刺活检前前列腺特异性抗原（PSA）值、穿刺病理Gleason评分、临床T分期、穿刺活检阳性针数率、危险度分级、前列腺体积与患者术后bRFS、OS的关系。结果:5、8年bRFS分别为75.0%、56.0%;5、8年OS分别为80.2%、62.1%;Gleason评分、穿刺活检阳性针数率、临床T分期、前列腺体积是bRFS的独立预测因素，而Gleason评分、临床T分期是OS的独立预测因素（P<0.05）;对于≤cT3a期前列腺癌，Gleason评分、穿刺活检阳性针数率、前列腺体积、危险度分级均是bRFS独立预测因素（P<0.05）,而Gleason评分是OS的独立预测因素（P<0.05）。结论:¹²⁵I粒子植入治疗低危组前列腺癌效果理想；中、高危组，尤其是T3a～T3b期及Gleason评分≥8分者，应考虑结合外放疗和内分泌治疗；腺体体积较大不影响术后bRFS和OS;穿刺活检阳性针数率偏高者，术后应加强对PSA值的监测，必要时行穿刺活检，明确复发原因，并给予针对性治疗。更多还原

【Abstract】 Objective: To evaluate the outcomes of low-dose-rate prostate brachytherapy（LDR-BT） and investigate the prognostic factors of biochemical relapse-free survival（bRFS） and overall survival（OS） in ≤cT3 prostate cancer after LDR-BT. Methods: One hundred and sixteen patients with ≤cT3 prostate cancer treated with ¹²⁵I LDR-BT as monotherapy or combined with homonal therapyfrom Jan, 2006 to Dec, 2016 in Second Hospital of Tianjin Medical University were retrospectively collected. Log-rank test and multivariable Cox regression were used to evaluate the relationship between covariates（PSA, clinical stage, prostate volume, et. al） and bRFS, OS. Results: Five-and eight-year bRFS and OS were 75.0% and 56.0%, 80.2% and 62.1%, respectively; Multivariate Cox analysis showed that Gleason score, the percentage of positive biopsy cores（%PC）, clinical T stage and PV were correlated with bRFS; Gleason score and clinical T stage were correlated with OS; For patients with ≤cT3a prostate cancer, Gleason score, %PC, PV and risk group were correlated with bRFS; Only Gleason score was an independent predictor of OS. Conclusion: Low-risk PCa patients are the most suitable candidates for LDR-BT, while the intermediate-or high-risk PCa, specially for stage cT3a-cT3b or Gleason score≥8, LDR-BT combined with external radiotherapy and hormone therapy may be considered. Very large PV does not influence bRFS rate or OS. The PCa with high %PC should be paid more attention to biochemical recurrence（BCR）, even biopsy when necessary, to clarify the cause of BCR for definite therapy.更多还原