前列腺癌根治术后病理提示神经周围侵犯的危险因素及其对术后复发的影响  

Risk factors of pathological changes of nerve peripheral invasion and its impact on postoperative recurrence after radical prostatectomy

作　　者：张鲁东[1] 崔丽丽 马勇[1] 苗发陈 王站成[1] ZHANG Ludong;CUI Lili;MA Yong;MIAO Fachen;WANG Zhancheng .(Department of Urology, Shanxian Central Hospital, Shanxian, Shandong, 274300, Chin)

机构地区：[1]单县中心医院泌尿外科,山东单县274300

出　　处：《临床泌尿外科杂志》2018年第3期238-241,共4页Journal of Clinical Urology

摘　　要：目的:探究前列腺癌根治术后病理提示神经周围侵犯的危险因素及其对术后复发的影响。方法:选取2012年5月~2016年5月我院收治的、符合纳入标准的前列腺癌患者116例,根据病理是否提示神经周围侵犯分为对照组(66例)和试验组(50例),试验组病理提示有神经周围侵犯。观察两组的肿瘤分期、术前血清PSA、精囊侵犯、包膜侵犯、前列腺穿刺评分、根治病理评分、术后血清PSA、淋巴结转移等情况,并进行多因素分析;以及分析试验组复发与未复发者之间与临床资料进行相关性和多因素分析。结果:(1)术前、术后一般情况:两组在肿瘤分期(χ~2=15.401,P=0.009)、术后血清PSA(t=5.154,P<0.001)、精囊侵犯(χ~2=4.932,P=0.026)、包膜侵犯(χ~2=4.311,P=0.038)、前列腺穿刺评分(χ~2=8.152,P=0.017)、根治病理评分(χ~2=9.301,P=0.010)均有差异。(2)一般情况多因素分析:试验组的肿瘤分期[OR=2.171,95%CI(1.080~4.361),P=0.030]、包膜侵犯[OR=2.307,95%CI(1.148~4.636),P=0.0019]、前列腺穿刺评分[OR=2.081,95%CI(1.193~3.631),P=0.010]、根治病理评分[OR=2.525,95%CI(1.291~3.930),P=0.004]为独立相关。(3)生化复发与未生化复发相关性分析:复发与肿瘤分期(χ~2=11.279,P=0.046)、术前血清PSA(t=2.037,P=0.047)、精囊侵犯(χ~2=9.475,P=0.002)有关。(4)生化复发与未生化复发多因素分析:复发与肿瘤分期[OR=2.145,95%CI(1.004~4.579),P=0.049]、术前血清PSA[OR=1.839,95%CI(1.013~3.336),P=0.045]、精囊侵犯[OR=2.540,95%CI(1.225~5.265),P=0.012]为独立相关。结论:神经周围侵犯为预测前列腺癌的进展与预后的重要因素。Objective： To explore the risk factors of pathological changes of nerve peripheral invasion and its impact on postoperative recurrence after radical prostatectomy. Method.. From May 2012 to May 2016, 116 pa- tients with prostate cancer who met the inclusion criteria in our hospital were selected. According to the pathologi- cal changes of nerve peripheral invasion, these patients were divided into control group （n=66） and experimental group （n=50）. Patients of the experimental group were found the pathological changes of nerve peripheral inva- sion. The tumor staging, preoperative serum PSA, seminal vesicle invasion, capsule invasion, prostate puncture score, radical pathologic score, postoperative serum PSA, lymph node metastasis were observed in two groups. We analyzed the correlation and multi factor analysis of recurrence and non recurrence in the experimental group. Result： ①The preoperative and postoperative general condition： the two groups in the tumor stage （X^2=15. 401, P〈0. 009）, postoperative serum PSA （t=5. 154, P〈0.001）, seminal vesicle invasion （X^2=4. 932, P=0. 026）, capsular invasion（X^2=4. 311, P = 0. 038）, prostate biopsy score （X^2=8. 152, P = 0. 017）, radical pathological score （X2 ： 9. 301, P：0. 010） were different. ②Multivariate analysis of general situation： the tumor stage [OR= 2. 171, 95%CI （1.080-4.361）, P=0.030], capsular invasion [0R=2.307, 95%CI （1.148-4.636）, P 0. 0019], prostate biopsy score [0R=2. 081, 95%CI（1. 193-3. 631）, P=0. 010], radical pathological score [OR=2. 525, 95%CI （1. 291-3. 930）, P=0. 004]were independently associated. GCorrelation between biochemical recurrence and non biochemical recurrence： the tumor stage（zz= 11. 279, P= 0. 046）, preoperative serum PSA （t=2. 037, P=0. 047）, seminal vesicle invasion（X^2=9. 475, P=0. 002） were related to recurrence. @Multivari- ate analysis of biochemical recurrence and biochemical relapse： recurrence and tumor staging [OR=2, 145, 95%CI （1. 004

关 键 词：前列腺癌 神经周围侵犯 根治术后 复发 

分 类 号：R737.25[医药卫生—肿瘤]