前列腺癌根治术后切缘阳性相关危险因素分析  

RISK FACTORS FOR POSITIVE SURGICAL MARGIN AFTER RADICAL PROSTATECTOMY FOR PROSTATE CANCER

作　　者：刘泽华 谢飞 刘风霞[2] 何蕾[2] 李延江[1] LIU Zehua;XIE Fei;LIU Fengxia;HE Lei;LI Yanjiang(Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China)

机构地区：[1]青岛大学附属医院泌尿外科,山东青岛266003 [2]青岛大学附属医院崂山院区手术室,山东青岛266003

出　　处：《精准医学杂志》2022年第1期65-70,74,共7页Journal of Precision Medicine

基　　金：山东省自然科学基金青年基金项目(ZR2020-QH238)。

摘　　要：目的探讨前列腺癌患者根治性前列腺切除术(RP)术后切缘阳性(PSM)的相关危险因素。方法回顾性分析青岛大学附属医院2015年1月-2021年7月接受腹腔镜下RP(LRP)或机器人辅助下RP(RARP)的816例前列腺癌患者的临床资料,根据术后前列腺病理标本的切缘状态将患者分为切缘阴性组(443例)和切缘阳性组(373例),收集患者临床资料,包括患者确诊年龄、BMI指数、高血压史、糖尿病病史、术前血清总前列腺特异性抗原(tPSA)水平、术前血清前列腺特异性抗原密度(PSAD)、术前血清游离前列腺特异性抗原/总前列腺特异性抗原(fPSA/tPSA)比值、术前血清前列腺酸性磷酸酶(PAP)水平、术前血清粒淋比(NLR)、术前前列腺体积(超声评估)、穿刺Gleason评分、术后Gleason评分、手术时间及前列腺是否突入膀胱,分析以上因素对PSM的影响。结果两组患者间确诊年龄、BMI指数、术前前列腺体积及术前血清fPSA/tPSA比值、术前血清NLR比较差异无显著性(P>0.05),两组患者术前血清tPSA水平、术前血清PSAD、术前血清PAP水平及穿刺Gleason评分、术后Gleason评分比较差异有显著性(Z=-9.829~-3.104,P<0.01)。多因素二元Logistic回归分析显示,穿刺Gleason评分(OR=1.846,95%CI=1.611~2.117,P<0.01),术前血清tPSA水平(OR=1.013,95%CI=1.008~1.018,P<0.01),术前血清PAP水平(OR=1.013,95%CI=1.002~1.025,P<0.05)及前列腺是否突入膀胱(OR=1.640,95%CI=1.171~2.299,P<0.01)为RP术后PSM的独立危险因素。利用回归方程绘制上述危险因素联合预测模型的受试者工作特征(ROC)曲线,曲线下面积(AUC)为0.710(95%CI=0.675~0.745)。结论穿刺Gleason评分、术前血清tPSA水平、术前血清PAP水平及前列腺是否突入膀胱为RP术后PSM的独立危险因素,本结论可更好地辅助临床医生为患者制定积极治疗措施,从而改善患者的预后。Objective To investigate the risk factors for positive surgical margin(PSM)after radical prostatectomy(RP)for patients with prostate cancer.Methods A retrospective analysis was performed for the clinical data of 816 patients with prostate cancer who underwent laparoscopic RP or robot-assisted RP in The Affiliated Hospital of Qingdao University from January 2015 to July 2021,and according to the resection margin status of the postoperative pathological prostate specimen,the patients were divided into negative surgical margin group with 443 patients and positive surgical margin group with 373 patients.Related clinical data were collected,including age at confirmed diagnosis,body mass index(BMI),history of hypertension,history of diabetes,preoperative serum total prostate-specific antigen(tPSA),preoperative serum prostate-specific antigen density(PSAD),preoperative serum free prostate-specific antigen(fPSA)/tPSA ratio,preoperative serum prostatic acid phosphatase(PAP),preoperative serum neutrophil-to-lymphocyte ratio(NLR),preoperative prostate volume(assessed by ultrasound),puncture Gleason score,time of operation,and whether the prostate entered the bladder,and the influence of the above factors on PSM was analyzed.Results There were no significant differences between the two groups in age at confirmed diagnosis,BMI,preoperative prostate volume,preoperative serum fPSA/tPSA ratio,and preoperative serum NLR(P>0.05),while there were significant differences between the two groups in preoperative serum tPSA,preoperative serum PSAD,preoperative serum PAP,puncture Gleason score,and postoperative Gleason score(Z=-9.829 to-3.104,P<0.01).The multivariate binary logistic regression analysis showed that puncture Gleason score(OR=1.846,95%CI=1.611-2.117,P<0.01),preoperative serum tPSA(OR=1.013,95%CI=1.008-1.018,P<0.01),preoperative serum PAP(OR=1.013,95%CI=1.002-1.025,P<0.05),and whether the prostate entered the bladder(OR=1.640,95%CI=1.171-2.299,P<0.01)were the risk factors for PSM after RP.The regression equation was used to

关 键 词：前列腺肿瘤 前列腺切除术 切缘 危险因素 回归分析 

分 类 号：R737.25[医药卫生—肿瘤] R699.8[医药卫生—临床医学]