根治性膀胱切除术患者前列腺受肿瘤累及的危险因素分析  

Assessment of risk factors for prostatic tumor invasion in patients undergoing radical cystectomy

作　　者：李梦强[1] 江绍钦 蔡伟忠[1] 江玮[1] 郑松[1] 李永生[1] 许恩赐[1] 

机构地区：[1]福建医科大学附属协和医院泌尿外科,福州350001

出　　处：《中华泌尿外科杂志》2016年第3期169-173,共5页Chinese Journal of Urology

基　　金：福建医科大学教授基金（JS09092）

摘　　要：目的 探讨行根治性膀胱切除术（radical cystectomy,RC）的膀胱癌患者中膀胱癌累及前列腺与膀胱癌合并偶发前列腺癌的危险因素.方法 收集2009年3月至2014年11月123例行RC的男性患者的临床和病理资料.年龄31 ～ 78岁,平均60岁.肿瘤位于膀胱颈和三角区50例.多发膀胱癌61例.膀胱肿瘤＞5cm者32例.高级别膀胱癌55例.pT分期：pTx期2例,pTa期9例,pT1期40例,pT2期39例,pT3期19例,pT4期14例.pN分期：pN0期107例,pN1期5例,pN2期11例.腹腔镜手术84例,开放手术39例.分析膀胱癌患者的年龄、肿瘤大小、位置、数量、肿瘤分级分期同膀胱癌累及前列腺及膀胱癌合并偶发前列腺癌的关系.结果 本组123例中,23例（18.7％）为膀胱癌累及前列腺或膀胱癌偶发前列腺癌,其中膀胱癌累及前列腺患者14例（11.4％）、偶发前列腺癌患者11例（8.9％）.膀胱癌累及前列腺的危险因素为多发病灶（OR=9.79,P=0.032）、癌位于膀胱颈和三角区（OR=17.13,P=0.013）、高pT分期（OR=26.70,P＜0.001）.11例偶发前列腺癌患者中,Gleason评分≥7分3例（27.3％）,≤6分8例（72.7％）;前列腺癌浸润包膜外组织2例（18.2％）.其中3例为有临床意义的偶发前列腺癌.膀胱癌合并偶发前列腺癌的危险因素为高龄（P =0.003）.结论 RC患者前列腺受肿瘤累及的危险因素为高龄、膀胱癌位于膀胱颈和三角区、多发病灶及高pT分期.Objective To identify the risk factors for prostate-sparing cystectomy by evaluating the risk of prostatic invasion or incidental prostatic adenocarcinoma （PCa） in bladder cancer （BCa） patients undergoing radical cystectomy.Methods The patients undergoing radical cystectomy from 2009 to 2014 in Fujian Medical University Union Hospital were enrolled to analyze the risk factors of prostatic tumor invasion.These factors included age,tumor size,location,quantity,histologic grade and pathologic stage.Results In the 123 male patients,the mean age was 60 years （range,31-78 years）;23 （18.7%） patients had BCa or PCa in the prostate;14 （11.4%） had prostatic Bca;11 （8.9%） had PCa.The risk factors of prostatic BCa included multifocal bladder tumors （OR =26.70,P =0.032）,tumor in the bladder neck and trigone（OR =17.13,P =0.013）,pathological stage （OR =26.70,P 〈 0.001）.Among the 11 patients with PCa,3（27.3%） patients had Gleason score of ≥7,8（72.7%） patients ≤6 and 2（18.2%） patients had extracapsular extension.Three patients had clinically significant PCa.The factor of advanced age was associated with incidental PCa （P =0.003）.Conclusion The risk factors of prostatic tumor invasion in patients undergoing radical cystectomy included advanced age,bladder tumor in bladder neck and trigone,muhifocal bladder tumors,and advanced pathological stage.

关 键 词：膀胱肿瘤 前列腺腺癌 根治性膀胱切除术 保留前列腺膀胱切除术 

分 类 号：R737.14[医药卫生—肿瘤]