前列腺偶发癌的病理特征及不同治疗方式的预后分析  

The pathologic features and prognosis of different treatment for incidental prostate cancer

作　　者：邵金鹏 宋勇[1] 孙圣坤[1] 陈文政[1] 张帆[1] 赵健[1] 安子彦 符伟军[1] Shao Jinpeng;Song Yong;Sun Shengkun;Chen Wenzheng;Zhang Fan;Zhao Jian;An Ziyan;Fu Weijun(Department of Urology,Third Medical Center of Chinese PLA General Hospital,Bejing 100039,China;Medical School of Chinese PLA,Bejing 100853,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 [2]解放军医学院,北京100853

出　　处：《中华泌尿外科杂志》2024年第2期98-102,共5页Chinese Journal of Urology

摘　　要：目的探讨前列腺偶发癌的病理特征及不同治疗方式的预后。方法回顾性分析2007年1月至2021年12月解放军总医院收治的2427例行经尿道前列腺切除术患者的病例资料,患者术前诊断均为良性前列腺增生(BPH)。54例术后病理诊断为前列腺癌,发生率2.2%。年龄(72.3±7.2)岁。中位体质量指数(BMI)24.8(23.1,26.6)kg/m^(2)。术前前列腺特异性抗原(PSA)中位值5.7(3.2,11.1)ng/ml。前列腺体积中位值60.1(38.0,88.6)ml。结果本研究54例中,1例未行Gleason评分;余53例Gleason评分中位值6(6,7)分。国际泌尿病理协会(ISUP)分级1级31例(58.5%),2级10例(18.9%),3级7例(13.2%),4级1例(1.9%),5级4例(7.5%)。BPH术后有完整随访资料者45例,随访时间57(34.5,94.5)个月,其中行主动监测14例,雄激素剥夺治疗(ADT)15例,根治性前列腺切除术(RP)11例,放射性粒子植入1例,等待观察4例。11例行RP患者中,术后病理检查提示标本切缘均为阴性,未见神经、包膜外、精囊侵犯,以及淋巴结转移。行主动监测、ADT、RP组的BMI[(26.9±4.9)kg/m^(2)、(24.4±4.1)kg/m^(2)、(24.5±1.4)kg/m^(2)]、术前PSA[(6.3±4.2)ng/ml、(9.4±7.6)ng/ml、6.4(3.8,11.6)ng/ml],以及ISUP分级1级[10/14例、7/15例、7/11例]、2级[3/14例、2/15例、3/11例]、3级[1/14例、3/15例、1/11例]、4~5级[0/14例、3/15例、0/11例]比较差异均无统计学意义(P>0.05);3组的年龄[(71.2±6.6)岁、(75.3±7.4)岁、(66.6±4.7)岁]差异有统计学意义(P=0.007)。生存曲线显示,行主动监测、ADT、RP患者的5年无肿瘤进展(复发)生存率分别为92.9%、86.7%、100.0%,差异无统计学意义(P=0.291)。前列腺偶发癌患者5年肿瘤进展(复发)率为8.7%,肿瘤特异性病死率为2.2%。结论前列腺偶发癌的ISUP分级多为1级,5年肿瘤进展(复发)率和特异性病死率较低。前列腺偶发癌患者行主动监测、ADT和RP的生存期无明显差异。Objective To investigate the pathologic features and prognosis of different treatment for incidental prostate cancer.Methods The clinical data of 2427 cases of Benign prostatic hyperplasia(BPH)undergoing transurethral resection of prostste were analyzed retrospectively in the Department of Urology,PLA General Hospital from January 2007 to December 2021.Postoperative pathological diagnosis revealed prostate cancer in 54 cases,with an incidence rate of 2.2%.The mean patients age was(72.3±7.2)years old,the median value of body mass index(BMI)was 24.8(23.1,26.6)kg/m^(2),the median value of total prostate specific antigen(tPSA)before operation was 5.7(3.2,11.1)ng/ml,and the median value of prostate volume was 60.1(38.0,88.6)ml.Results Among the 54 cases,Gleason scoring was not performed in one case,and the median value of Cleason score was 6(6,7).According to the WHO/ISUP grade group(GG),58.5%(31/53)were assigned to grade 1,18.9%(10/53)to grade 2,13.2%(7/53)to grade 3,1.9%(1/53)to grade 4,and 7.5%(4/53)to grade 5.Forty-five patients were followed up,and the median follow-up time was 57(34.5,94.5)months.Among them,14 patients underwent active surveillance(AS),15 patients were treated with androgen deprivation therapy(ADT),11 patients were treated with RP,one patient was treated with radioactive seed implantation,and 4 patients underwent watchful waiting.Among ll patients who underwent radical prostatectomy,pathological examination indicated that all surgical margins were negative,with no evidence of nerve invasion,extracapsular extension,seminal vesicle involvement,or lymph node metastasis.BMI in AS,ADT and RP groups were(26.9±4.9)kg/m^(2),(24.4±4.1)kg/m^(2)and(24.5±1.4)kg/m^(2),the preoperative PSA were(6.3±4.2)ng/ml,(9.4±7.6)ng/ml and 6.4(3.8,11.6)ng/ml,GG 1 were 10/14 cases,47/15 cases and 7/11 cases,GG 2 were 3/14 cases,2/15 cases and 3/11 cases,GG 3 were 1/14 cases,3/15 cases and 1/11 cases,and GG 4-5 were 0/14 cases,3/15 cases and 0/11 cases.The differences had no statistically significance(P>0.05).The ages

关 键 词：前列腺肿瘤 前列腺偶发癌 主动监测 雄激素剥夺治疗 根治性前列腺切除术 

分 类 号：R737.25[医药卫生—肿瘤]