高危前列腺癌患者行机器人辅助根治性前列腺切除术后切缘阳性的影响因素  

Clinical factors of positive surgical margin after robot-assisted laparoscopic radical prostatectomy in patients with high-risk prostate cancer

作　　者：符伟军[1] 宋勇[1] 赵健[1] 邵金鹏 安子彦 周启玮 孙圣坤[1] 陈文政[1] 朱捷[1] 沈诞[1] 杜青山[1] 张帆[1] 刘侃[1] 张旭[1] Fu Weijun;Song Yong;Zhao Jian;Shao Jinpeng;An Ziyan;Zhou Qiwei;Sun Shengkun;Chen Wenzheng;Zhu Jie;Shen Dan;Du Qingshan;Zhang Fan;Liu Kan;Zhang Xu(Senior Department of Urology,Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第三医学中心泌尿外科医学部,北京100039

出　　处：《中华泌尿外科杂志》2022年第7期518-522,共5页Chinese Journal of Urology

摘　　要：目的探讨高危前列腺癌患者行机器人辅助根治性前列腺切除术(RARP)后切缘阳性的影响因素。方法回顾性分析2016年1月至2022年1月于解放军总医院行RARP的164例高危前列腺癌患者的临床资料。年龄(65.3±6.2)岁,体质指数(25.6±3.0)kg/m^(2),术前总前列腺特异性抗原(tPSA)中位值18.6(11.3,31.3)ng/ml,术前穿刺Gleason评分中位值7(7,8)分,前列腺体积中位值29.3(22.4,40.2)ml,临床分期为T_(2a)N_(0)M_(0)~T_(4)N_(0)M_(0)期。其中80例行新辅助内分泌治疗,均采用完全雄激素阻断疗法,中位疗程3(3~6)个月。所有患者均行RARP,手术均为单一术者施行。采用单因素分析评估患者年龄、体质指数、前列腺体积、新辅助内分泌治疗、术前tPSA、临床分期、术前穿刺Gleason评分与术后切缘阳性的关系,进一步采用多因素logistic回归分析术后切缘阳性的独立危险因素。结果术后病理:肿瘤局限于前列腺(pT2期)111例(67.7%),肿瘤突破前列腺包膜(pT_(3a)期)15例(9.1%),肿瘤侵犯精囊(pT_(3b)期)25例(15.2%),肿瘤侵犯邻近组织(pT_(4)期)13例(7.9%);患者均无淋巴结转移。术后Gleason评分6分11例(6.7%),3+4分26例(15.9%),4+3分36例(22.0%),8分17例(10.4%),9~10分24例(14.6%),因内分泌治疗等无法评分50例(30.5%);切缘阳性率为44.5%(73/164)。单因素分析结果显示行新辅助内分泌治疗、术前tPSA和临床分期与切缘阳性存在相关性(均P<0.05);多因素logistic回归分析结果显示,未行新辅助内分泌治疗、术前tPSA>20 ng/ml、临床分期>T_(2b)期是术后切缘阳性的独立危险因素(均P<0.05)。分层分析结果显示,在tPSA为10~20 ng/ml、临床分期T_(2c)期、穿刺Gleason评分7分亚组中,行新辅助内分泌治疗者切缘阳性率均明显低于未行新辅助内分泌治疗者[分别为21.1%(4/19)与55.9%(19/34),29.6%(16/54)与49.1%(26/53),19.4%(6/31)与54.1%(20/37)],差异均有统计学意义(P<0.05)。结论未行新辅助内分泌治疗、术前tPSA>20 ng/Objective To investigate the relationship between the positive surgical margin and clinical factors such as neoadjuvant hormonal therapy after robot-assisted laparoscopic radical prostatectomy(RARP)in high-risk patients with prostate cancer.Methods The clinical data of 164 patients with high-risk prostate cancer being performed RARP by one surgeon were analyzed retrospectively in our hospital from January 2016 to January 2022.The mean patient’s age was(65.3±6.2)years old,mean body mass index(BMI)was(25.6±3.0)kg/m^(2),the median value of total prostate specific antigen(tPSA)before operation was 18.6(11.3,31.3)ng/ml,the median value of Gleason score before operation was 7(7,8),the median value of prostate volume was 29.3(22.4,40.2)ml,and the clinical stage was T_(2a)N_(0)M_(0)-T_(4)N_(0)M_(0).80 patients with prostate cancer were treated with neoadjuvant endocrine therapy.All of them were treated with complete androgen blockade with a median course of 3 months.Univariate analysis was used to analyze the correlation between age,BMI,prostate volume,neoadjuvant hormonal therapy,preoperative tPSA,clinical stage,Gleason score before operation and positive surgical margin.Then multivariate logistic regression was used to further analyze the independent risk factor of positive surgical margin after RARP.Results The postoperative pathological diagnosis included pT2 stage in 111 cases(67.7%),pT_(3a)stage in 15 cases(9.1%),pT_(3b)stage in 25 cases(15.2%),pT_(4)stage in 13 cases(7.9%).No lymph node metastasis was noticed in all patients.The Gleason scores included 6 in 11 cases(6.7%),3+4 in 26 cases(15.9%),4+3 in 36 cases(22.0%),8 in 17 cases(10.4%),9-10 in 24 cases(14.6%),un-evaluation due to endocrine therapy in 50(30.5%).The positive surgical margin of high-risk patients with prostate cancer was 44.5%(73/164).Univariate analysis showed that the neoadjuvant hormonal therapy,tPSA and clinical stage were correlated with positive surgical margin(P<0.05).Multivariate logistic regression analysis showed that non-neoadjuvant

关 键 词：前列腺肿瘤 癌 机器人辅助根治性前列腺切除术 切缘阳性 新辅助内分泌治疗 

分 类 号：R737.25[医药卫生—肿瘤]