Clinical Efficacy Evaluation Of Neoadjuvant Hormonal Therapy Followed By Radical Prostatectomy

Object:Prostate cancer(PCa)plays a dominant role in prostate cancer among elderly men worldwide.It has the second highest incidence rate and the fifth highest mortality rate.However,the incidence of the disease in our country has been increasing year by year in recent years,and many people found it in the late stage.Prostate cancer has a wide range of consistency,and the natural course of disease has a variety of characteristics,its condition is complex,can choose a variety of treatment modes.For patients with high tumor burden,simple surgery is not effective,so more comprehensive and active systematic treatment should be adopted.Neoadjuvant endocrine therapy(NHT)is the application of neoadjuvant endocrine therapy before radical surgery.Although there have been a large number of studies on this aspect in the past,there is no clear and unified guidance on NHT in various guidelines.In addition,the characteristics of high tumor load in prostate cancer patients in China further explore the optimal population for the rational use of NHT.We retrospectively collected patients who underwent radical prostatectomy in shandong provincial hospital from 2010 to 2018,and analyzed the application of preoperative neoadjuvant therapy,postoperative pathological parameters and biochemical recurrence,aiming to provide a reasonable basis for neoadjuvant endocrine therapy for prostate cancer patients in China through data analysis.Method:Medical records of patients undergoing radical prostatectomy for prostate cancer in the department of urology,Shandong provincial hospital on January 1,2010 and November 30,2018 were retrospectively collected.According to the risk classification proposed by the Prostate Cancer "EAU Guildline on Prostate Cancer 2018" and the TNM staging in "NCCN Guidelines Version 3.2018",the preoperative neoadjuvant treatment status and postoperative pathological data of the patients were collected,and the propensity score matching was used to calculate the patients'propensity score and screen the patients with similar scores,so as to reduce the confounding factors generated by the baseline data.Follow-up was conducted according to patients'PSA information after postoperative review.T test was used for measurement data,chi-square test was used for counting data,Kaplan Meier method was used to draw the survival curve and calculate the median recurrence rate,Cox univariate proportional risk model was used to calculate the risk of biochemical recurrence of different pathological parameters,and multivariate cox stepwise regression model was used to analyze the independent predictors of biochemical recurrence after radical prostatectomy for prostate cancer.Result:A total of 134 patients were included in this study,with a matching tolerance of 0.05.Age,BMI,newly diagnosed PSA,and GLEASON score of puncture biopsy were used as covariables for propensity score matching.After matching,a total of 104 patients were successfully matched.There were 52 people in the RP+NHT group and 52 people in the RP alone group.In the RP+NHT group,33 patients were treated with NHT for less than 3 months(25 patients for 1 month,8 patients for 2 months),and 19 patients for more than 3 months(15 patients for 3 months,4 patients for 3 months with>).The patients were divided into the<3 month group and the group for more than 3 months.The differences in postoperative pathological parameters were not statistically significant.The matched patients were grouped according to risk degree and clinical stage,and the matched data were analyzed by stratification.The results showed that in patients with clinical stage T2,the positive rate of the cutting edge was significantly lower than that in the RP group(14.7%vs.38.5%,p=0.023).The rate of prostate apex invasion was significantly lower than that in the RP group(8.8%vs.34.2%,p=0.01),and the difference in pathological parameters was not statistically significant in the clinical staging T3 group.Among the risk groups,the positive rate of the middle incisal margin(19%vs.40%,p=0.033)and the invasion rate of the apex of the prostate(16.7%vs.38.6%,p=0.023)were statistically significant in the high-risk group.There was no significant difference in postoperative pathological parameters between the low-risk group and the medium-risk group.In the study,two patients were treated with neoadjuvant endocrine therapy and no residual tumor was found in postoperative pathology.A Cox univariate proportional risk model was used to determine the diagnosis of PSA(HR:1.009,P= 0.016),clinical T stage(HR:2.106,P=0.021),incisional margin status(HR:3.065,P= 0.005),lymph node status(HR:3.883,P= 0.001),and extrapentricular involvement(HR:2.104,P= 0.04).Multivariate cox regression model showed that lymph node status(HR:3.883,P =0.001)was an independent factor affecting postoperative recurrence of patients,among which the median biochemical recurrence time was 24 months in patients with positive lymph nodes and 43 months in patients with negative lymph nodes.Kaplan-meier analysis showed that preoperative neoadjuvant endocrine therapy had no significant effect on postoperative biochemical recurrence rate.Conclusion:1.In clinical practice,the duration of neo-adjuvant hormonal therapy is inconsistent,with the majority being less than 3 months,which still needs to be further standardized in application;2.Neoadjuvant hormonal therapy before radical prostatectomy for high-risk patients with prostate cancer at the cT-T2 stage can reduce the positive rate of surgical margin,reduce the invasion of the prostate tip and increase the tumor limitation;3.The effect of neoadjuvant hormonal therapy on local tumor control in patients with cT?T3 stage is uncertain.In clinical application,it should be clarified to patients that the treatment decision should be based on the potential clinical benefits,side effects and economic ability,which should be jointly decided by doctors and patients.4.There is a certain probability of pathological complete remission after neoadjuvant endocrine therapy,which should be clarified to patients before application.5.Lymph node status is an independent risk factor for postoperative biochemical recurrence,and neoadjuvant endocrine therapy has no significant effect on postoperative biochemical recurrence rate.