高危前列腺癌腹腔镜根治性前列腺切除术后切缘阳性的危险因素  

Risk factors for positive surgical margin after laparoscopic radical prostatectomy in high risk prostate cancer patients with and without neoadjuvant hormornal therapy

作　　者：王方明 韩苏军 杨飞亚 王明帅[2] 邢念增 Wang Fangming;Han Sujun;Yang Feiya;Wang Mingshuai;Xing Nianzen(Department of Urology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Urology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院泌尿外科,北京100021 [2]首都医科大学附属北京朝阳医院泌尿外科,北京100020

出　　处：《中华泌尿外科杂志》2021年第5期349-354,共6页Chinese Journal of Urology

摘　　要：目的探讨高危前列腺癌患者腹腔镜根治性前列腺切除术(LRP)后手术切缘阳性(PSM)的危险因素。方法回顾性分析2012年1月至2020年7月行LRP的202例高危前列腺癌患者的病例资料,其中北京朝阳医院111例,中国医学科学院肿瘤医院91例。年龄(67.7±6.5)岁,体质指数(25.65±3.21)kg/m^(2)。术前最高PSA中位值20.97(11.00,34.40)ng/ml。前列腺体积中位值32.88(23.33,46.20)ml。其中接受新辅助内分泌治疗(NHT)者(NHT组)105例,未接受NHT者(非NHT组)97例。NHT组与非NHT组穿刺前最高PSA[23.67(12.68,45.72)ng/ml与18.11(10.30,26.82)ng/ml,P=0.013]、前列腺体积[30.00(21.55,45.96)ml与36.40(28.08,46.80)ml,P=0.042]差异均有统计学意义,年龄[(68.53±6.40)岁与(66.89±6.58)岁,P=0.073]、体质指数[(25.91±3.14)kg/m^(2)与(25.37±3.33)kg/m^(2),P=0.231]差异无统计学意义。NHT方案中完全雄激素阻断治疗80例,中位疗程3个月;单纯去势治疗3例,中位疗程3个月;单纯抗雄治疗22例,中位疗程1个月。分别分析NHT组和非NHT组影响PSM的危险因素。结果NHT组和非NHT组的PSM率分别为24.8%(26/105)和50.5%(49/97)。前列腺基底部是NHT组最常见的阳性部位(14.3%,15/105),尖部是非NHT组最常见的阳性部位(35.1%,34/97)。多因素logistic回归分析结果显示,NHT组术后病理T分期(OR=18.434,95%CI 4.976~68.297,P<0.001)、术后淋巴结阳性(OR=7.181,95%CI 2.089~24.689,P=0.002)、脉管癌栓(OR=3.545,95%CI 1.109~11.327,P=0.033)是PSM的独立危险因素;非NHT组术后病理T分期是PSM的独立危险因素(OR=3.814,95%CI 1.302~11.173,P=0.015)。结论无论是否接受NHT治疗,术后病理T分期均是高危前列腺癌患者LRP术后PSM的独立危险因素。接受NHT的患者,术后淋巴结阳性、脉管癌栓亦是PSM的独立危险因素。Objective To explore risk factors for positive surgical margin(PSM)after laparoscopic radical prostatectomy(LRP)in high risk prostate cancer(PCa)patients with and without neoadjuvant hormornal therapy(NHT).Methods The clinicopathological data of 202 high risk patients who underwent LRP from January 2012 to July 2020 was retrospectively analyzed.There were 111 cases performed in Beijing Chaoyang Hospital and 91 cases in National Cancer Center.Mean age was(67.7±6.5)years,mean BMI was(25.65±3.21)kg/m^(2).Median highest preoperative PSA was 20.97(11.00,34.40)ng/ml,median preoperative prostate volume was 32.88(23.33,46.20)ml.Among all 202 high risk PCa patients,97 did not receive NHT(non-NHT group)and 105 received NHT(NHT group).There were significant statistical difference in term of highest PSA,preoperative prostate volume between NHT and non-NHT groups(P<0.05),while there was no significant difference in term of age or BMI between the two groups.Among NHT patients,80 cases accepted complete androgen blockade therapy with median course of 3 months;3 cases accepted simple castration therapy with median course of 3 months;22 cases accepted simple anti-androgen therapy with median course of 1 month.Risk factors for PSM after LRP in NHT and non-NHT groups were respectively explored,including age,BMI,hypertension,diabetes,history of pelvic surgery,highest PSA before puncture,ISUP before puncture,preoperative prostate volume,ISUP after LRP,postoperative pathological stage T,pathological lymph node involvement,vessel carcinoma embolus,etc.Results PSM rate was 50.5%(49/97)and 24.8%(26/105)in non-NHT and NHT,respectively.The apex was the most common location of PSM in non-NHT group(35.1%,34/97),while the fundus was the most common location of PSM in NHT group(14.3%,15/105).Multiple logistic regression revealed that postoperative pathological stage T was the only independent factors affecting the PSM for high risk patients without NHT(OR=3.814,95%CI 1.302-11.173,P=0.015),while postoperative pathological stage T,pathological

关 键 词：前列腺肿瘤 新辅助内分泌治疗 切缘阳性 腹腔镜根治性前列腺切除术 

分 类 号：R737.25[医药卫生—肿瘤]