前列腺癌根治术后病理提示神经周围侵犯对预测生化复发的价值  

Value of perineural invasion in predicting biochemical recurrence after radical prostatectomy

作　　者：林健海 阴雷[1] 汪存洲[1] 琚官群 曹万里 尹海龙 王军凯[1] 姚亚成[1] 任吉忠[1] 刘冰[1] 王林辉[1] LIN Jianhai;YIN Lei;WANG Cunzhou;JU Guanqun;CAO Wanli;YIN Hailong;WANG Junkai;YAO Yacheng;REN Jizhong;LIU Bing;WANG Linhui(Department of Urology,Changzheng Hospital,Second Military Medical University,Shanghai,200003,China)

机构地区：[1]第二军医大学附属长征医院泌尿外科,上海200003

出　　处：《临床泌尿外科杂志》2020年第4期253-256,263,共5页Journal of Clinical Urology

基　　金：上海市科委基础重点项目(No:14JC1491200)。

摘　　要：目的:探讨前列腺癌根治术后病理提示神经周围侵犯(PNI)的相关危险因素以及对术后生化复发的影响。方法:回顾性分析2016年10月~2018年8月,在我院接受前列腺癌根治术治疗的前列腺癌病例220例。根据术后标本病理提示是否存在PNI进行分组,对比两组间在年龄、术前PSA、穿刺标本及根治标本Gleason评分、TNM分期、包膜侵犯、精囊侵犯、切缘阳性、神经周围侵犯等临床病理参数的差异。采用Kaplan-Meier法绘制生存曲线,并应用Log-rank检验比较生存曲线之间的统计学差异。单因素及多因素Cox比例风险回归模型分析与术后生化复发相关的临床病理因素。结果:本研究220例病例中,PNI的检出率为18.6%。PNI组与无PNI组,在穿刺活检及根治病理Gleason评分、pT分期、pN分期、包膜侵犯及精囊侵犯等方面比较的差异有统计学意义(P<0.05)。PNI组的无生化复发生存率更低。多因素COX比例风险回归分析提示:PNI、术前PSA、根治标本Gleason评分等与前列腺癌根治术后生化复发显著相关。结论:PNI是预测前列腺癌根治术后生化复发的独立危险因素。Objective: To determine whether perineural invasion(PNI) is associated with clinicopathological characteristics and biochemical recurrence(BCR) after radical prostatectomy(RP). Method: A retrospective analysis was performed on 220 cases of prostate cancer in Shanghai Changzheng Hospital from October 2016 to August 2018. We compared the baseline characteristics between the groups according to the presence of PNI, including age, preoperative serum prostate-specific antigen, biopsy and pathologic Gleason score, TNM stage, capsule invasion, seminal vesicle invasion, surgical margin status. We used the Kaplan-Meier method to estimate the biochemical recurrence-free survival and conducted the log-rank test to compare the statistical significance between survival curves. The Cox proportional hazards regression model was adopted to test the possible factors of BCR. Result: Among 220 patients, PNI was detected in 18.6% patients. PNI was associated with higher biopsy and pathologic Gleason score, pathological T stage, pathological N stage, capsule invasion and seminal vesicle invasion(P<0.05). BCR-free survival was lower in patients with PNI. PNI, preoperative serum prostate-specific antigen and pathologic Gleason score were significantly associated with an increased risk of BCR after RP in the multivariate analysis. Conclusion: PNI is an independent predictor for BCR in prostate cancer patients who underwent RP.

关 键 词：前列腺癌 生化复发 神经周围侵犯 

分 类 号：R737.25[医药卫生—肿瘤]