局限高危前列腺癌患者根治性前列腺切除术后生化失败率及其影响因素分析  

Analysis of biochemical failure rate and its influencing factors in patients with high-risk localized prostate cancer after radical prostatectomy

作　　者：赵强[1] 洪保安 纪永鹏 杜鑫 杨勇[1] 张宁[1,2] Zhao Qiang;Hong Baoan;Ji Yongpeng;Du Xin;Yang Yong;Zhang Ning(Department of Urology,Peking University Cancer Hospital&Institute,Key laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Beijing 100142,China;Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所泌尿外科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]首都医科大学附属北京安贞医院泌尿外科,北京100029

出　　处：《中华泌尿外科杂志》2023年第3期161-166,共6页Chinese Journal of Urology

摘　　要：目的分析局限高危前列腺癌患者行根治性前列腺切除术(RP)后生化失败率及其影响因素。方法回顾性分析2015年1月至2021年11月于北京大学肿瘤医院行RP的166例局限高危前列腺癌患者的临床资料。年龄(65.4±6.2)岁,体质量指数(BMI)(24.86±3.23)kg/m^(2),前列腺特异性抗原(PSA)中位值19.84(10.98,44.47)ng/ml,PSA密度0.68(0.34,1.32)ng/m^(2),前列腺体积31.20(25.58,40.23)ml。穿刺病理按照国际泌尿病理学会(ISUP)分级分组:1组18例,2组33例,3组30例,4组51例,5组33例,不详1例;穿刺阳性针数占比(55.4±25.7)%,穿刺阳性病灶线性长度最大占比80.0%(60.0%,90.0%)。术前临床分期≤T2b期14例,T2c期117例,T3a期13例,≥T3b期22例;N0期157例,N1期9例。103例(62.0%)应用传统影像学检查评估,63例(38.0%)应用前列腺特异性膜抗原(PSMA)PET-CT检查评估。患者行腹腔镜根治性前列腺切除术。166例中64例(38.6%)行新辅助治疗,治疗1~3个月37例,4~6个月23例,>6个月4例。分析患者术后病理特征、治疗和预后情况,主要研究终点为生化失败,包括生化持续(术后4~6周PSA≥0.1 ng/ml)和生化复发(术后PSA降至<0.1 ng/ml,无辅助治疗或辅助治疗结束后PSA升高≥0.2 ng/ml)。结果术后病理ISUP分级分组较穿刺病理升级48例(28.9%),T分期升级98例(59.0%),N分期升级13例(7.8%)。切缘阳性率53%(88/166),尖端切缘阳性最常见(65.9%,58/88)。114例(68.7%,114/166)术后PSA降至<0.1 ng/ml,其中74例未行辅助治疗,40例接受辅助治疗;52例(31.3%,52/166)术后PSA未降至<0.1 ng/ml,其中51例接受挽救性治疗。5例(3.0%,5/166)在辅助治疗或挽救性内分泌治疗过程中出现PSA进展,考虑发生去势抵抗。患者中位随访时间25.5(12.0,40.0)个月,生化失败78例(48.4%,78/161),其中生化持续49例,生化复发29例,无生化失败中位时间为30.0(95%CI 14.5~45.5)个月,术后接受辅助治疗者较未接受辅助治疗者生化复发率降低[15.8%(6/38)与31.1%(23/74),P=0.08]。基�Objective To analyze the biochemical failure rate and its predictive factors after radical prostatectomy(RP)in patients with high-risk localized prostate cancer.Methods The data of 166 patients with high-risk localized prostate cancer who underwent RP surgery in Peking university cancer hospital from January 2015 to November 2021 were retrospectively reviewed.The average age was 65.4±6.2 years old,and the average body mass index(BMI)was 24.86±3.23 kg/m^(2).The median prostate-specific antigen(PSA)was 19.84(10.98,44.47)ng/ml,PSA density was 0.68(0.34,1.32)ng/m^(2),and prostate volume was 31.20(25.58,40.23)ml.Biopsy pathology Gleason score according to the International society of Urological Pathology(ISUP)grade group:18 cases of group 1,33 cases of group 2,30 cases of group 3,51 cases of group 4,and 33 cases of group 5,1 case was unknown.The percentage of puncture positive needles was(55.4±25.7)%,and the largest linear length of positive lesions was 80.0%(60.0%,90.0%).Preoperative clinical stage:14 cases in≤T2b stage,117 cases in T2c stage,13 cases in T3a stage and 22 cases in≥T3b stage;157 cases in N0 stage,9 cases in N1 stage.One hundred and three patients(62.0%)were assessed by traditional imaging and 63(38.0%)were assessed by PSMA PET-CT.The patients underwent laparoscopic radical prostatectomy.64 patients(38.6%)received neoadjuvant therapy,including 37 received neoadjuvant therapy for 1-3 months,23 for 4-6 months and 4 for over 6 months.The postoperative pathological characteristics,treatment and prognosis of the patients were analyzed.The primary endpoint was biochemical failure,including biochemical persistence(BCP,defined as PSA≥0.1ng/ml at 4-6 weeks after operation,and confirmed by re-examination at least 1 week interval)and biochemical recurrence(BCR,PSA falling below 0.1ng/ml after operation and then rising≥0.2 ng/ml without adjuvant therapy or after the end of adjuvant treatment).Results Compared with preoperative clinicopathological characteristics,48(28.9%)cases had postoperative pathologi

关 键 词：前列腺肿瘤 癌 高危 局限 根治性前列腺切除术 生化失败 生化复发 

分 类 号：R737.25[医药卫生—肿瘤]