前列腺癌根治术切缘阳性对患者术后生化复发的影响  

Effect of positive surgical margin on postoperative biochemical recurrence of prostate cancer after radical prostatectomy

作　　者：方志伟[1] 胡浩[1] 梁晨[1] 王焕瑞 张维宇[1] 许克新[1] FANG Zhiwei HU Hao LIANG Chen WANG Huanrui ZHANG Weiyu XU Kexin(Department of Urology, Peking University People＇s Hospital, Beijing, 100044, China)

机构地区：[1]北京大学人民医院泌尿外科,北京100044

出　　处：《临床泌尿外科杂志》2017年第9期678-681,共4页Journal of Clinical Urology

摘　　要：目的:评估切缘阳性对前列腺癌根治术患者术后生化复发的影响。方法:对我院2009年1月~2015年12月111例腹腔镜前列腺癌根治术患者进行随访,采集患者人口学资料、病理学信息等基本资料,采取电话回访的方式随访患者。以连续2次PSA>0.2ng/ml为生化复发诊断标准。结果:100例患者完成随访,切缘阴性患者68例,切缘阳性患者32例,其中19例患者术后接受辅助放疗或辅助内分泌治疗,平均随访时间(31.98±21.03)个月。切缘阳性组与切缘阴性组相比,年龄、随访时间、术前PSA差异无统计学意义,切缘阳性组患者术后病理分期及Gleason评分高于切缘阴性组(P<0.05)。Kaplan-Meier生存分析显示切缘阳性组与切缘阴性组比较患者无生化复发中位生存期差异无统计学意义(59个月vs.56个月,P>0.05)。COX比例风险模型多因素分析显示切缘阳性患者术后生化复发风险上升2.631倍,辅助治疗患者术后生化复发降低66.7%。结论:前列腺癌根治术后切缘阳性是患者术后生化复发的独立危险因素,但切缘阳性患者接受辅助治疗后生化复发率与切缘阴性组无显著差异。Objective：To evaluate the effect of positive surgical margin on postoperative biochemical recurrence of prostate cancer after radical prostatectomy.Method：From January 2009 to December 2015,111 patients who underwent radical prostatectomy in our hospital were followed up.The demographic data and pathological information were collected.Biochemical recurrence was defined by two consecutive PSA values0.2ng/ml.Result：One hundred patients were finally recruited to this study.Sixty-eight of them had negative margins,while other patients had positive margins.Among them,19 patients received adjuvant radiotherapy or adjuvant endocrine therapy after surgery,with an average follow-up period of（31.98±21.03）months.There was no significant difference in the age,follow-up period and preoperative PSA between the positive group and the negative margin group.But the T stage and Gleason score of the positive margin group were higher than those of the negative margin group（P〈0.05）.Kaplan-Meier survival analysis showed that there was no significant difference in median survival between patients with positive surgical margins and negative margins（59vs.56 months,P〉0.05）.Multivariate analysis of the COX proportional hazards model showed that the risk of biochemical recurrence was 2.631 times higher in patients with positive margins.And the risk reduced 66.7%in patients after adjuvant treatment.Conclusion：Positive margin after radical prostatectomy is an independent risk factor for postoperative recurrence.But after adjuvant radiotherapy or adjuvant endocrine therapy,there was no significant difference in the biochemical recurrence rate of the patients with positive margin after radical prostatectomy.

关 键 词：前列腺癌 切缘阳性 生化复发 

分 类 号：R737.25[医药卫生—肿瘤]