T1a^T1b期前列腺癌的诊断与治疗  

Diagnosis and treatment of T1a- T1b prostate cancer

作　　者：刘茁[1] 罗程[1] 胡帅[1] 范宇[1] 刘振华[1] 杨新宇[1] 沈棋[1] 刘漓波[1] 韩文科[1] 周利群[1] 虞巍[1] 何群[1] 张骞[1] 金杰[1] 

机构地区：[1]北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,北京100034

出　　处：《北京大学学报（医学版）》2016年第5期812-816,共5页Journal of Peking University:Health Sciences

摘　　要：目的:探讨经尿道前列腺电切术后偶发前列腺癌(即T1a^T1b期前列腺癌)的临床病理特点,提高对该病的诊疗认识。方法:回顾性分析2004年5月至2013年9月北京大学第一医院泌尿外科977例因良性前列腺增生(benign prostatic hypertrophy,BPH)而行经尿道前列腺电切手术(transurethral resection of prostate,TURP)患者的临床病理资料,选择其中总前列腺特异抗原(total prostate specific antigen,t PSA)≤10μg/L,且既往无前列腺或膀胱手术史者共771例,对TURP组织病理标本进行全部取材,由专业病理科医师进行分析,描绘HE染色切片显微镜下的肿瘤轮廓,采用Image J 1.47h软件采集图像,测量肿瘤面积,将每例患者所有切片中的肿瘤面积相加,估算的肿瘤体积等于肿瘤测量面积总和乘以模块厚度。收集患者的临床及病理资料,随访其治疗方式、前列腺特异性抗原(prostate specific antigen,PSA)进展情况、干预治疗的原因及方式、肿瘤特异性病死率等。结果:本组患者发现偶发癌86例,检出率为11.2%,此86例患者肿瘤体积0.4~180.2 mm3,其中T1a期77例(89.5%),平均肿瘤体积为(12.3±12.6)mm3,T1b期9例(10.5%),平均肿瘤体积为(105.1±41.8)mm3。所有患者肿瘤体积均<500 mm3,属于小体积前列腺癌。肿瘤Gleason评分,<7分者79例,≥7分者7例。86例患者初步治疗方案均为等待观察,其中2例失访,中位随访时间88.9个月(27.9~150.1个月)。共5例患者发生PSA进展,其中T1a期4例,T1b期1例,此5例患者均选择干预治疗。T1b期有1例患者虽然未发生PSA进展,但因患者意愿强烈也选择了干预治疗。T1a期患者中,1例选择前列腺根治性切除术,术后未见生化复发;3例选择内分泌治疗,未见治疗后PSA进展。T1b期1例患者选择放疗,未见放疗后生化复发,1例选择内分泌治疗,未见治疗后PSA进展。获得随访的84例患者中非前列腺癌特异性死亡者6例,未见前列腺癌特异性死亡者。结论:本研究偶发�Objective： To explore the clinical pathological characteristics and improve the recognition in the diagnosis and treatment of incidental（ stage T1a- T1b） prostate cancer. Methods： Seven hundred and seventy-one patients who underwent TURP from May 2004 to September 2013 were analyzed retrospectively. In our institution,TURP specimens should be totally submitted in an extensive sampling method. The tumor area was outlined by estimation of an experienced genitourinary pathologist and calculated by the image analysis system software（ Image J 1. 47 h）. The tumor area was then multiplied by the thickness of tissue. The total sum of all tumor volume was the estimated tumor volume. The clinical and pathological factors,follow-up results were obtained and we aimed to collect information about the period of watchful waiting（ WW）,PSA progression status,intervention status during the follow-up,the reason for intervention on WW and the type of intervention. Results： The average age of 771 patients was（ 71. 3 ± 5. 9） years old,and the average BMI was（ 23. 9 ± 3. 1） kg /m2,preoperative average t PSA was（ 4. 4 ± 2. 8） μg /L. Eighty-six（ 11. 2%） cases of incidental prostate cancer were detected. The patients in T1 a group（ 77 cases,89. 5%） had tumor volumes of（ 12. 3 ± 12. 6） mm3,and the patients in T1 b group had tumor volumes of（ 105. 1 ± 41. 8） mm3. The range of tumor volume was 0. 4- 180. 2 mm3.The volume of all the 86 cases was less than 500 mm3 as the threshold of insignificant cancer. All the patients were managed by WW. The mean follow-up time was 88. 9（ 27. 9- 150. 1） months. The Gleason score was 7 in 79 patients,and ≥7 in 7 patients. There was no significant difference in age,preoperative t PSA,preoperative PSAD,postoperative t PSA,prostate volume and TURP resection between T1 a group and T1 b group（ P〉0. 05）. Among 84 patients without follow-up losts,PSA progression occurred in 5 patients. One T1 a patient underwent radical prostatectomy（ RP） as an in

关 键 词：前列腺肿瘤 前列腺 经尿道前列腺电切术 

分 类 号：R737.2[医药卫生—肿瘤]