根治性前列腺切除术后切缘阳性患者的预后分析  

Prognostic analysis of patients with pathological positive margins after radical prostatectomy

作　　者：张远东 张伟[2] 刘龙腾[2] 王淼 侯惠民[1] 王建龙[1] 张亚群[1] 张耀光[1] 朱生才[1] 丁鑫[1] 刘明 Zhang Yuandong;Zhang Wei;Liu Longteng;Wang Miao;Hou Huimin;Wang Jianlong;Zhang Yaqun;Zhang Yaoguang;Zhu Shengcai;Ding Xin;Liu Ming(Department of Urology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pathology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院泌尿外科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [2]北京医院病理科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [3]北京大学医学部第五临床医学院,北京100730 [4]中国医学科学院北京协和医学院研究生院,北京100730

出　　处：《中华泌尿外科杂志》2021年第9期691-695,共5页Chinese Journal of Urology

摘　　要：目的探讨根治性前列腺切除术后切缘阳性患者的预后情况,并分析前列腺特异性抗原(PSA)进展的危险因素。方法回顾性分析2012年5月至2020年8月北京医院收治的141例根治性前列腺切除术后切缘阳性患者的临床资料。年龄(67.4±6.7)岁,术前中位PSA 9.6(1.4~152.8)ng/ml。其中行开放手术17例,腹腔镜手术124例;42例未行淋巴结清扫,35例行局限性淋巴结清扫,64例行扩大淋巴结清扫。术后病理分期:T_(2)期74例,T_(3)期63例,T_(4)期4例。国际泌尿病理协会(ISUP)分级分组1组32例,2组50例,3组31例,4组16例,5组12例。根治术后生化复发定义为根治术后连续两次随访PSA>0.2 ng/ml并有上升趋势。本研究中将根治术后随访期间血清PSA≥0.1 ng/ml而未达生化复发定义为PSA进展。分析切缘阳性患者的预后。采用单因素和多因素Cox回归分析PSA进展的危险因素。结果本研究141例中位随访52(1~104)个月。其中PSA进展组69例(48.9%),非PSA进展组72例(51.1%)。PSA进展组中,13例(18.8%)未接受治疗,其中8例出现生化复发;4例(5.8%)仅接受单纯放疗,其中2例出现生化复发;52例(75.4%)接受内分泌治疗或内分泌治疗联合放疗,其中5例(9.6%)出现去势抵抗。多因素Cox回归分析结果显示术前PSA(HR=1.015,95%CI 1.005~1.025,P=0.004)、ISUP分级分组(HR=1.351,95%CI 1.091~1.673,P=0.006)、手术方式(HR=2.233,95%CI 1.141~4.370,P=0.019)是PSA进展的危险因素。结论RP术后有较高的切缘阳性率。近1/2的切缘阳性患者根治术后存在PSA进展。切缘阳性患者术前PSA、ISUP分级分组、手术方式是PSA进展的危险因素,对于具有上述危险因素的患者应密切监测和积极治疗。Objective To analyze the prognosis of patients with positive resection margin after radical prostatectomy,as well as the prostate-specific antigen(PSA)level and risk factors for PSA progression.Methods A retrospective analysis was performed on the data of 141 patients with pathologically diagnosed prostate cancer who underwent RP from May 2012 to August 2020 in Beijing Hospital.The mean age was(67.4±6.7)years,the preoperative median PSA was 9.6(1.4-152.8)ng/ml and the median follow-up time was 56 months.Postoperative pathology was T_(2) stage 74(52.5%),T_(3) stage 63(44.7%),T_(4) stage 4(2.8%).Biochemical recurrence after radical resection was defined as PSA rose to more than 0.2 ng/ml and showed an upward trend after two consecutive follow-ups.In this study,serum PSA≥0.1 ng/ml without biochemical recurrence after radical operation was defined as PSA progression.The PSA level,risk factors of PSA progression and prognosis of patients with positive resection margin were analyzed.Univariate and multivariate Cox regression analysis was used to analyze the correlation between age,preoperative PSA level,pathological stage(pT),ISUP classification,surgical approach,lymph node dissection,single/multiple positive margins and PSA progression.Results The median follow-up of 141 patients was 52 months(1-104 months).There were 69(48.9%)patients in the PSA progression group and 72(51.1%)patients in the non PSA progression group.In the PSA progression group,13(18.8%)patients did not receive treatment and 8(61.5%)patients had biochemical recurrence.4(5.8%)patients received radiotherapy alone,and 2(50.0%)patients had biochemical recurrence.52(75.4%)patients received endocrine therapy or endocrine therapy combined with radiotherapy,and 5(9.6%)patients developed castration resistance.Multivariate Cox regression analysis showed preoperative PSA(HR=1.015,95%CI 1.005-1.025,P=0.004),ISUP grade and group(HR=1.351,95%CI 1.091-1.673,P=0.006),surgical method(HR=2.233,95%CI 1.141-4.370,P=0.019)was correlated with PSA progression.Conclusio

关 键 词：前列腺肿瘤 切缘阳性 预后 前列腺特异性抗原进展 

分 类 号：R737.25[医药卫生—肿瘤]