摘要
目的探讨提高挽救性淋巴结清扫术对于生化复发前列腺癌患者的治疗效果。方法 2015～2017年我院收治并接受前列腺特异性膜抗原(PSMA)单光子发射计算机化断层显像(SPECT)/CT检查引导下行挽救性淋巴结清扫术的前列腺癌患者,对其中3例典型患者进行回顾性分析。结果病例1行前列腺癌根治术(RP)后,前列腺特异性抗原(PSA)再次升高,PSMA SPECT/CT示左侧髂总血管旁肿大淋巴结,遂行双侧扩大盆腔淋巴结清扫术,术后患者PSA下降至0.2 ng/mL以下,维持8个月后再次升高;病例2 RP患者术后PSA再次升高为22 ng/mL,PSM A SPECT/CT示腹膜后淋巴结肿大,遂行腹膜后淋巴结清扫术,术后PSA逐渐下降,3个月后最低至10 ng/mL,随后再次反弹;病例3行前列腺癌根治性放疗,患者PSA下降后逐渐升至4 ng/mL,PSM A SPECT/CT示右侧髂血管旁放射性摄取增高灶,遂行扩大盆腔淋巴结清扫术+放疗,PSA下降至0.2 ng/mL以下,维持14个月后逐渐升高。结论对于生化复发前列腺癌患者,若PSA水平较低且出现孤立淋巴结转移灶,PSMA SPECT/CT引导下的挽救性淋巴结切除术可作为综合治疗手段之一使患者获益。
Objective To improve the value of salvage lymph node dissection for patients treated with radical prostatectomy( RP) with biochemical recurrence. Methods The clinical data of 3 typical cases treated with 99mTc-prostate-specific membrane antigen( PSMA) single photon emission computed tomography( SPECT)/CT guided salvage lymph node dissection during 2015 and 2017 were retrospectively analyzed. Results In case 1,the prostate specific antigen( PSA) control was not satisfactory after RP. PSMA SPECT/CT showed suspicious lymph node metastases near the left iliac blood vessels. After extended pelvic lymphadenectomy,the PSA level decreased to 0.2 ng/mL for 8 months and then increased again. In case 2,the PSA level increased to 22 ng/mL after RP. PSMA SPECT/CT showed suspicious retroperitoneal lymph node metastases. After retroperitoneal salvage lymph node dissection,the PSA level decreased to10 ng/mL in 3 months and then bounced back. In case 3,after radical radiation,the PSA level gradually decreased and then increased to 4 ng/mL. PSMA SPECT/CT showed suspicious lymph node metastases near the right iliac blood vessels. After salvage pelvic lymph node dissection plus radiation,the PSA level decreased to less than 0.2 ng/mL for 14 months and then increased. Conclusion For prostate cancer patients with biochemical recurrence,lowPSA level and isolated nodal recurrence after RP,PSMA SPECT/CT guided salvage lymph node dissection can alleviate tumor burden and benefit the patients.
作者
宿恒川
朱耀
戴波
刘畅
胡四龙
叶定伟
SU Hengchuan;ZHU Yao;DAI Bo;LIU Chang;HU Silong;YE Dingwei(Department of Urology,Shanghai Cancer Center of Fudan University,Shanghai Medical College,Fudan University,Shanghai 200032,China;Department of Nuclear Medicine,Shanghai Cancer Center of Fudan University,Shanghai 200032,China)
出处
《山东大学学报（医学版）》
CAS
北大核心
2019年第1期36-40,共5页
Journal of Shandong University:Health Sciences
基金
国家自然科学基金(81602222)
第五批上海市青年医师培养计划(2017年)
关键词
前列腺特异性膜抗原
前列腺癌
转移灶
挽救性淋巴结清扫术
Prostate-specific membrane antigen
Prostate cancer
Metastatic lesions
Salvage lymph node dissection
