机器人辅助腹腔镜根治性前列腺切除术后切缘阳性和生化复发的影响因素及相关性分析  

The correlation analysis of positive surgical margin and biochemical recurrence after robot-assisted laparoscopic radical prostatectomy

作　　者：张春雷[1,2] 陈锐 孔德沛[1] 杨琦 瞿旻 陈欢[1] 訾晓渊[1] 孙颖浩 高旭[1] Zhang Chunlei;Chen Rui;Kong Depei;Yang Qi;Qu Min;Chen Huan;Zi Xiaoyuan;Sun Yinghao;Gao Xu(Department of Urology,Shanghai Changhai Hospital,Shanghai 200433,China)

机构地区：[1]上海长海医院泌尿外科,200433 [2]解放军联勤保障部队第九四0医院

出　　处：《中华泌尿外科杂志》2018年第12期905-910,共6页Chinese Journal of Urology

摘　　要：目的探讨机器人辅助腹腔镜根治性前列腺切除术(RALP)标本切缘阳性和生化复发的影响因素,以及二者的相关性。方法回顾性分析2016年1月至2017年9月我院由单一术者行RALP治疗的190例局限性或局部进展性前列腺癌患者的临床资料。年龄(67.5±6.9)岁,中位体重指数为24.2kg/m^2(16.6~34.2kg/m^2),术前PSA中位值为15.00ng/ml(1.41~393.94ng/ml),前列腺重量中位值为36.90g(8.65~207.58g)。根据切缘是否阳性及阳性位置,将患者分为切缘阴性、单纯下切缘(尖部切缘)阳性、单纯上切缘(膀胱颈切缘)阳性和两端切缘(尖部切缘和膀胱颈切缘)阳性4组。患者切缘阳性率及生化复发率的差异分析采用χ2检验,对切缘阳性的影响因素分析采用二分类资料logistic回归,对生化复发的独立危险因素分析采用Cox回归分析,对不同位置切缘阳性患者生化复发率的比较采用log-rank检验。结果190例中术后病理切缘阴性143例(75.3%),切缘阳性47例(24.7%),其中25例(13.2%)为单纯下切缘阳性,11例(5.8%)单纯上切缘阳性,11例(5.8%)两端切缘均为阳性。多因素logistic分析结果显示术前PSA(P=0.048)和病理分期(P=0.004)是切缘阳性的独立影响因素。190例术后随访时间中位值为7.3个月(0.9~26.6个月),37例(19.5%)出现生化复发。生化复发率在切缘阴性、单纯下切缘阳性、单纯上切缘阳性和两端切缘阳性患者中分别为15.4%(22/143)、16.0%(4/25)、27.3%(3/11)和72.7%(8/11),logHrank检验结果显示两端切缘阳性患者的生化复发率高于切缘阴性(P<O.001)和单纯下切缘阳性的患者(P=0.002)。多因素Cox回归分析结果表明,术前高PSA(P=0.040)、高级别病理分期(P=0.041)及术后高Gleason评分(P=O.004)是生化复发的独立危险因素,而切缘阳性不是生化复发的独立危险因素(P=0.257)。结论术前PsA和病理分期是PALP标本切缘阳性的独立影响因素,术前高PsA、高级别病理分期及术后高Gleason评分是生�Objective To explore the influencing factors and correlation of positive surgical margin (PSM)and biochemical recurrence (BCR)in men after robot-assisted radical prostatectomy (RALP). Methods The clinical data of 190 patients with local or locally advanced prostate cancer who underwent RALP by single surgeon in the Department of Urology of Changhai Hospital from January 2016 to September 2017 were collected.Age was (67.5±6.9)years old;median body mass index (BMI),preoperative PSA, prostate weight were 24.2kg/m^2(16.6-34.2kg/m^2),15.0ng/ml (1.41-393.94ng/ml)and 36.9g (8.65-207.58g)respectively.The group of surgical margin was divided into negative surgical margin, apex-only PSM,base-only PSM as well as apex and base PSM.Characteristics between patients stratified by surgical margin or BCR were compared using X2test.The influencing factors of PSM were analyzed by logistic regression.Cox regression was used for the analysis of predictive factors of BCR.Log-rank test and Kaplan-Meier curves were used for comparing the BCR rate between the groups of surgical margin.Results Of all the 190 enrolled patients,total PSM rate was 24.7%(47/190),apex-only PSM rate was 13.2% (25/190),base-only PSM rate was 5.8%(11/190),apex and base PSM rate was 5.8%(11/190). Multivariate analysis showed the independent predictive factors influencing PSM were preoperative PSA (P = 0.048)and pathological stage (P =0.004).The median follow-up period was 7.3months (0.9-26.6 months)and BCR happened in 19.5%(37/190)patients.The rates of BCR were 15.4%(22/143), 16.0%(4/25),27.3%(3/11)and 72.7%(8/11)in the patients with negative surgical margin,apexonly PSM,base-only PSM and both apex and base PSM respectively.Log-rank test revealed that the rate of BCR in patients with apex and base PSM was higher than that in patients with negative surgical margin (P < 0.001)or patients with apex-only PSM (P =0.002).Cox analysis indicated that higher preoperative PSA (P =0.040),higher pathological stage (P =0.041)and higher pathological Gleason score (P =0.004) we

关 键 词：前列腺肿瘤 根治性前列腺切除术 机器人 切缘阳性 生化复发 

分 类 号：R737.25[医药卫生—肿瘤]