摘要：寡转移性前列腺癌 （oligometastatic prostate cancer，OMPC） 主要是由转移的部位和数量定义的。与传 统意义上的肿瘤转移不同，OMPC是一种介于局限和广泛转移之间的，被认为是潜在可治愈的疾病。国际上对于 OMPC的诊疗尚未达成共识，但近年以雄激素剥夺治疗 （androgen deprivation therapy，ADT） 为主的全身治 疗以及局限性放疗为主的局部治疗的发展受到学者们的广泛关注。本文对近期国内外关于 OMPC诊断、治疗的 研究进展等相关文献进行了总结。

暂无相关信息！

[1] HELLMAN S,WEICHSELBAUM R R. Oligometastases [J]. J Clin Oncol,1995,13(1):8-10

[2] RAO A,VAPIWALA N,SCHAEFFER E M,et al. Oligometastatic Prostate Cancer: A Shrinking Subset or an Opportunity for Cure? [J]. Am Soc Clin Oncol Educ Book, 2019,39:309-320

[3] PFISTER D,PORRES D,HEIDENREICH A,et al. Detection of recurrent prostate cancer lesions before salvage lymphadenectomy is more accurate with 68Ga- PSMAHBED- CC than with 18F- Fluoroethylcholine PET/CT [J]. Eur J Nucl Med Mol Imaging,2016,43(8):1410-1417

[4] ASOKENDARAN M E,MEYRICK D P,SKELLY L A, et al. Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography compared with diagnostic computed tomography in relapsed prostate cancer [J]. World J Nucl Med,2019,18(3):232-237

[5] PERERA M,PAPA N,CHRISTIDIS D,et al. Sensitivity, Specificity, and Predictors of Positive 68 Ga-Prostate-specific Membrane Antigen Positron Emission Tomography in Advanced Prostate Cancer: A Systematic Review and Meta-analysis [J]. Eur Urol,2016,70(6):926-937

[6] BOLLA M,DEREIJKE TM,VAN TIENHOVEN G,et al. Duration of androgen suppression in the treatment of prostate cancer [J]. N Engl J Med,2009,360(24):2516-2527

[7] DAVIS I D,MARTIN A J,STOCKLER M R,et al. Enzalutamide with Standard First- Line Therapy in Metastatic Prostate Cancer [J]. N Engl J Med,2019,381(2):121-131

[8] CHI K N,AGARWAL N,BJARTELL A,et al. Apalutamide for Metastatic, Castration- Sensitive Prostate Cancer [J]. N Engl J Med,2019,381(1):13-24

[9] JAMES N D,DEBONO J S,SPEARS M R,et al. Abiraterone for Prostate Cancer Not Previously Treated with Hormone Therapy [J]. N Engl J Med,2017,377(4):338-351

[10] STOYANOVA T,COOPER A R,DRAKE J M,et al. Prostate cancer originating in basal cells progresses to adenocarcinoma propagated by luminal- like cells [J]. Proc Natl Acad Sci U S A,2013,110(50):20111-20116

[11] WANG Y,QIN Z,WANG Y,et al. The role of radical prostatectomy for the treatment of metastatic prostate cancer: a systematic review and meta- analysis [J]. Biosci Rep, 2018,38(1):BSR20171379

[12] STEVENS D J,SOORIAKUMARAN P. Oligometastatic Prostate Cancer [J]. Curr Treat Options Oncol,2016,17(12): 62

[13] SOORIAKUMARAN P,WILSON C,ROMBACH I,et al. Feasibility and safety of radical prostatectomy for oligometastatic prostate cancer: the Testing Radical prostatectomy in men with prostate cancer and oligo- Metastases to the bone (TRoMbone) trial [J]. BJU Int,2022,130(1):43-53

[14] CHENG B,YE S,BAI P. The efficacy of cytoreductive surgery for oligometastatic prostate cancer: a meta- analysis [J]. World J Surg Oncol,2021,19(1):160

[15] CORNFORD P,VAN DEN BERGH R C,BRIERS E, et al. EAU- EANM- ESTRO- ESUR- SIOG Guidelines on Prostate Cancer. Part Ⅱ 2020 Update: Treatment of Relapsing and Metastatic Prostate Cancer [J]. Eur Urol,2021, 79(2):263-282

[16] INGROSSO G,TRIPPA F,MARANZANO E,et al. Stereotactic body radiotherapy in oligometastatic prostate cancer patients with isolated lymph nodes involvement: a twoinstitution experience [J]. World J Urol,2017,35(1):45-49

[17] OST P,REYNDERS D,DECAESTECKER K,et al. Surveillance or Metastasis- Directed Therapy for Oligometastatic Prostate Cancer Recurrence: A Prospective, Randomized, Multicenter Phase Ⅱ Trial [J]. J Clin Oncol,2018,36 (5):446-453

[18] SOLANKI A A,BOSSI A,EFSTATHIOU J A,et al. Combining Immunotherapy with Radiotherapy for the Treatment of Genitourinary Malignancies [J]. Eur Urol Oncol, 2019,2(1):79-87

[19] PASQUALETTI F,PANICHI M,SOLLINI M,et al. [18F] Fluorocholine PET/CT- guided stereotactic body radiotherapy in patients with recurrent oligometastatic prostate cancer [J]. Eur J Nucl Med Mol Imaging,2020,47(1):185-191

[20] DEIJEN C L,VRIJENHOEK G L,SCHAAKE E E,et al. PSMA-11-PET/CT versus choline-PET/CT to guide stereotactic ablative radiotherapy for androgen deprivation therapy deferral in patients with oligometastatic prostate cancer [J]. Clin Transl Rad Oncol,2021,30:1-6

[21] HÖLSCHER T,BAUMANN M,KOTZERKE J,et al. Toxicity and Efficacy of Local Ablative, Image- guided Radiotherapy in Gallium- 68 Prostate- specific Membrane Antigen Targeted Positron Emission Tomography-staged, Castration-sensitive Oligometastatic Prostate Cancer: The OLIP Phase 2 Clinical Trial [J]. Eur Urol Oncol,2022,5(1):44- 51

[22] DEODATO F,PEZZULLA D,CILLA S,et al. Stereotactic radiosurgery for bone metastases in oligometastatic prostate cancer patients: DESTROY- 2 clinical trial subanalysis [J]. Clin Transl Oncol,2022,24(6):1177-1183

[23] TELKHADE T,MURTHY V,KANALA T S,et al. Safe-ty and Efficacy of Ultra- hypofractionation in Node- positive Prostate Cancer [J]. Clinical Oncology,2021,33(3):172- 180

[24] ZAORSKY N G,KEITH S W,SHAIKH T,et al. Impact of radiation therapy dose escalation on prostate cancer outcomes and toxicities [J]. Am Clin Oncol,2018,41(4):409- 415

[25] CHAW C L,DESOUZA N M,KHOO V,et al. Clinical Outcomes of Stereotactic Body Radiotherapy With Immediate Versus Delayed Hormone Therapy in Men With Oligometastatic Recurrence of Prostate Cancer [J]. Clin Oncol, 2020,32(8):509-517

[26] ROSS A E,HURLEY P J,TRAN P T,et al. A Pilot Trial of Pembrolizumab plus Prostatic Cryotherapy for Men with Newly Diagnosed Oligometastatic Hormone- Sensitive Prostate Cancer [J]. Prostate Cancer Prostatic Dis,2020,23 (1):184-193

[27] CLARKE N W,ALJ A,INGLEBY F C,et al. Addition of docetaxel to hormonal therapy in low- and high- burden metastatic hormone sensitive prostate cancer: long- term survival results from the STAMPEDE trial [J]. Ann Oncol, 2019,30(12):1992-2003

[28] GRAVIS G,BOHER J M,JOLY F,et al. Androgen Deprivation Therapy (ADT) Plus Docetaxel Versus ADT Alone in Metastatic Non castrate Prostate Cancer: Impact of Metastatic Burden and Long- term Survival Analysis of the Randomized Phase 3 GETUG-AFU15 Trial [J]. Eur Urol, 2016,70(2):256-262

[29] SHEIKHBAHAEI S,REYES D K,ROWE S P,et al. CTbased assessment of body composition following neoadjuvant chemohormonal therapy in patients with castrationnaïe oligometastatic prostate cancer [J]. Prostate,2021,81(2): 127-134

[30] CLEMENT J M,SWEENEY C J. Evolving Treatment of Oligometastatic Hormone- Sensitive Prostate Cancer [J]. J Oncol Pract,2017,13(1):9-18

[31] COMISKEY M C,DALLOS M C,DRAKE CG. Immunotherapy in Prostate Cancer: Teaching an Old Dog New Tricks [J]. Current Oncology Reports,2018,20(9):75

[32] VELHO P I,ANTONARAKIS E S. PD-1/PD-L1 Pathway Inhibitors in Advanced Prostate Cancer [J]. Expert Rev Clin Pharmacol,2018,11(5):475-486

[33] DUDZINSKI S O,CAMERON B D,WANG J,et al. Combination immunotherapy and radiotherapy causes an abscopal treatment response in a mouse model of castration resistant prostate cancer [J]. J Immunother Cancer,2019,7(1): 218

[34] CRITTENDEN M,KOHTH,LEVY R,et al. Current clinical trials testing combinations of immunotherapy and radiation [J]. Semin Radiat Oncol,2015,25(1):54-64

[35] KWON E D,DRAKE C G,SCHER H I,et al. Ipilimumab versus placebo after radiotherapy in patients with metastatic castration- resistant prostate cancer that had progressed after docetaxel chemotherapy (CA184-043): a multicentre, randomised, double- blind, phase 3 trial [J]. Lancet Oncol,2014,15(7):700-712. 

薛一博,崔芦伟,石红林. 寡转移性前列腺癌的诊断与治疗[J]. 泌尿外科杂志（电子版）,2022,14(1):62-65. DOI:10.3969/j.issn.1674-7410.2022.01.016.

暂无相关信息！

寡转移的概念由Hellman和Weichseibaum于1995年提出，定义为存在局部局限和广泛播散之间的一种中间状态的肿瘤，转移限制在单个或有限数量的部位和器官上[1] 。学者们还将寡转移性前列腺癌 （oligometastatic prostate cancer， OMPC）细分为初诊寡转移、寡复发和寡进展。前瞻性试验通常将 寡转移限制为最多 3个转移灶，其他公认标准为5个转移灶或更多。目前对于寡转移的定义仍然存在争 议，本文对 OMPC 的相关研究进行汇总，希望能对临床OMPC的诊断及治疗以启发。

1 诊断

2 治疗
    2.1 雄激素剥夺治疗 （androgen deprivation therapy，ADT）
    2.2 减瘤手术
    2.3 立体定向消融放疗 （stereotactic ablative radiotherapy，SABR）
    2.4 冷冻疗法
    2.5 化 疗
    2.6 免疫疗法

3 小结

3 小结 

近年关于 OMPC 的研究发展迅速，随着影像学 技术的发展，以放疗为主的局部治疗越来越被重 视。大量研究证实，局部治疗无论是在延长生存期、 减少复发率，降低手术切缘阳性率以及延迟ADT治疗 时间方面均有益处，安全性也不错。此外，即刻 ADT 治疗以及加用恩杂鲁胺/阿帕鲁胺均对 OMPC患者有益。减瘤手术可提高 OMPC 患者生存率、减 轻局部症状、增加放疗敏感性。研究显示免疫治疗 联合放疗或冷冻治疗对 OMPC 有益。而化疗的作用 尚不完全清楚，且有较严重不良反应。综上所述， 以 ADT 为基础的全身治疗以及 SABR、减瘤手术、 冷冻消融等的联合疗法是 OMPC 的发展方向，但需 根据患者的病情及意愿，同时结合当地医疗条件选 择相应的治疗方案。

暂无相关信息！

暂无相关信息！