前列腺癌根治标本提示神经周围侵犯对预测前列腺癌进展和预后的价值  

Value of perineural invasion in prostatectomy specimen in the assessment on tumor progression and prognosis

作　　者：朱寅杰[1] 王艳青[1] 潘家骅[1] 董柏君[1] 徐凡[1] 沙建军[1] 薛蔚[1] 黄翼然[1] 

机构地区：[1]上海交通大学医学院附属仁济医院泌尿外科,200127

出　　处：《中华外科杂志》2016年第3期217-221,共5页Chinese Journal of Surgery

基　　金：国家自然科学基金资助项目（91129725）;上海市科委资助项目（14140901700）

摘　　要：目的 探讨前列腺癌根治标本提示神经周围侵犯（PNIp）的危险因素及其对术后生化复发的影响.方法 回顾性分析2002年12月至2014年5月上海交通大学医学院附属仁济医院收治的502例局限性前列腺癌患者的临床资料,根据前列腺癌根治标本提示是否有神经周围侵犯分为PNIp组（n=411）和无PNIp组（n=91）.收集两组患者术前血清PSA、前列腺穿刺病理Gleason评分、根治病理Gleason评分、肿瘤T分期、包膜侵犯情况、手术切缘阳性情况、精囊侵犯情况、盆腔淋巴结转移情况、术后最低血清前列腺特异抗原（PSA）等临床病理参数和术后生化复发情况.Logistic回归分析PNIp与各临床病理参数的独立相关性;Log-rank检验和Cox回归分析临床病理参数与生化复发的相关性.结果 本研究502例患者中,有PNIp 91例（18.1％）、无PNIp 411例（81.9％）.有PNIp和无PNIp两组术前血清PSA、前列腺穿刺病理Gleason评分、根治病理Gleason评分、肿瘤T分期、包膜侵犯、精囊侵犯、术后最低血清PSA比较差异均有统计学意义（P值均＜0.05）.Logistic回归分析结果显示,PNIp与前列腺穿刺病理Gleason评分、根治病理Gleason评分、肿瘤T分期、包膜侵犯率（OR=1.515、1.955、2.069、1.859）独立相关,差异均有统计学意义（P值均＜0.05）.本研究中生化复发121例（26.7％）.术前血清PSA、前列腺穿刺病理Gleason评分、根治病理Gleason评分、肿瘤T分期、神经周围侵犯、精囊侵犯与生化复发有关,均有统计学意义（P＜0.05）.Cox回归分析结果显示,术前血清PSA、前列腺穿刺病理Gleason评分、PNIp、精囊侵犯（HR=1.021、1.441、1.663、3.257）是预测生化复发的独立相关因素,均有统计学意义（P值均＜0.05）.结论 PNIp是前列腺癌进展及预后的重要预测因素.Objective To assess perineural invasion in prostatectomy specimen （PNIp）on tumor progression and prognosis after radical prostatectomy.Methods Retrospective analysis including 502 prostate cancer patients admitted in Renji Hospital,School of Medicine,Shanghai Jiaotong University from December 2002 to May 2014 was studied.Differences of serum prostate specific antigen（PSA）,Gleason score of prostate biopsy,Gleason score of prostatectomy specimen,tumor stage,capsular invasion,positive surgical margin,seminal invasion,pelvic lymph node metastasis,nadir PSA were analyzed in patients with PNIp and without PNIp.Logistic regression analysis,Log-rank test and Cox regression analysis was used to analyzed the data,respectively.Results There were 91 patients with PNIp （18.1%） and 411 patients without PNIp （81.9%）.Differences of serum PSA,Gleason score of prostate biopsy,Gleason score of prostatectomy specimen,tumor stage,capsular invasion,seminal invasion,nadir PSA between the two groups were found（all P 〈 0.05）.In the multivariable logistic regression analysis,PNIp was independent predictor of Gleason score of prostate biopsy,Gleason score of prostatectomy specimen,tumor stage,capsular invasion （OR =1.515,1.955,2.069,1.859,all P 〈 0.05）.One hundred and twenty-one patients with biochemical serum recurrence（26.7%）.Serum PSA,Gleason score of prostate biopsy,Gleason score of prostatectomy specimen,tumor stage,PNIp,seminal invasion were related to biochemical serum recurrence （P 〈 0.05）.In the multivariable cox regression analysis,serum PSA,Gleason score of prostate biopsy,PNIp,seminal invasion were independent predictors of biochemical serum recurrence （HR =1.021,1.441,1.663,3.257,all P 〈0.05）.Conclusion PNIp is the important predictor of the tumor progression and prognosis of prostate cancer.

关 键 词：前列腺肿瘤 外科手术 前列腺癌根治术 神经周围侵犯 

分 类 号：R737.25[医药卫生—肿瘤]