前列腺穿刺后不同时间间隔行根治性前列腺切除术患者的生存预后分析  

Comparing survival outcomes of patients with different time intervals between puncture and radical resection forprostatecancer

作　　者：刘郴郴 魏志豪 陈凯磊 曹琪 章小平 Liu Chenchen;Wei Zhihao;Chen Kailei;Cao Qi;Zhang Xiaoping(Department of Urology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院泌尿外科,武汉430022

出　　处：《中华泌尿外科杂志》2024年第2期108-113,共6页Chinese Journal of Urology

摘　　要：目的比较前列腺癌患者前列腺穿刺后不同时间间隔行根治性前列腺切除术(RP)的短期并发症和长期生存预后的差异。方法回顾性分析2014年5月至2019年5月武汉协和医院收治的185例前列腺癌患者的病例资料, 所有患者均接受RP。根据患者前列腺穿刺确诊至根治手术的时间间隔分为≤2周组和≥4周组。≤2周组103例, 年龄67(63, 73)岁;体质量指数(BMI)23.66(22.17, 25.44)kg/m^(2);伴高血压病40例(38.8%), 糖尿病13例(12.7%);总前列腺特异性抗原(tPSA)20.63(11.88, 48.50)ng/ml, 53例(51.0%)≥20 ng/ml, f/tPSA 0.10(0.07, 0.15);30例(29.1%)穿刺病理Gleason评分≥8分;73例(70.9%)行机器人辅助根治性前列腺切除术(RARP);39例(37.8%)根治术后病理Gleason评分≥8分;69例(67.0%)病理分期Ⅲ~Ⅳ期。≥4周组82例, 年龄67(62, 69)岁;BMI 23.56(21.73, 24.91)kg/m^(2);伴高血压病35例(42.7%), 糖尿病11例(13.4%);tPSA 20.84(14.38, 46.25)ng/ml, 43例(52.0%)≥20 ng/ml, f/tPSA 0.12(0.10, 0.15);31例(37.8%)穿刺病理Gleason评分≥8分;66例(80.5%)行RARP;41例(50.0%)根治术后病理Gleason评分≥8分;58例(70.7%)病理分期Ⅲ~Ⅳ期。为减少数据偏差和混杂因素干扰, 基于患者年龄、BMI、高血压病、糖尿病、tPSA、穿刺Gleason评分、手术方式等进行倾向得分匹配, 获得71对可比病例, 两组的基线资料比较差异无统计学意义(P>0.05)。分析配对后两组的术中出血量、手术时间、术后住院时间、切缘阳性率、尿控功能等指标差异。采用Kaplan-Meier法绘制生存曲线。采用Cox回归比较两组的总生存率(OS)、无进展生存率(PFS)和疾病特异性生存率(DSS)差异, 分析影响患者生存的危险因素。比较PSA≥20 ng/ml、根治术后病理Gleason评分≥8分、病理分期Ⅲ~Ⅳ期亚组患者中不同时间间隔分组的生存差异。结果匹配的71对患者中130例有完整生存信息, 中位随访时间52(39, 71)个月。≤2周组的手术时间为244(186, 252)min, 术中Objective To investigate the differences in short-term postoperative complications and long-term survival prognosis in patients with different time interval between prostate needle biopsy and radical prostatectomy(RP).Methods The clinical data of 185 patients who underwent RP at the department of urology,Wuhan Union hospital between May 2014 and May 2019 were analyzed retrospectively.According to the time interval between biopsy and RP,they were divided into≤2 weeks and≥4 weeks group.Among them,103 cases underwent RP within 2 weeks with age of 67(63,73)years old,with BMI of 23.66(22.17,25.44)kg/m^(2),hypertension in 40 cases(38.8%),diabetes in 13 cases(12.7%),and diagnosed PSA of 20.63(11.88,48.50)ng/ml,including 53 cases(51.0%)above 20 ng/ml.The f/t PSA value was 0.1(0.07,0.15),with 30(29.1%)cases of biopsy Cleason score≥8,and 73(70.9%)cases undergoing RARP.In 39 cases(37.8%),the radical Gleason score was≥8,and 69(67.0%)cases were pathologically staged II-IV.There were 82 cases undergoing RP after 4 weeks,with age of 67(62,69)years old,BMI of 23.56(21.73,24.91)kg/m^(2),hypertension in 35 cases(42.7%),diabetes in 11 cases(13.4%)and diagnosed PSA of 20.84(14.38,46.25)ng/ml,including 43 cases(52.0%)above 20 ng/ml.The f/t PSA value was 0.12(0.10,0.15),with 27(32.9%)cases of biopsy Gleason score≥8,and 66(80.5%)cases undergoing RARP.In 41 cases(50.0%),the radical Gleason score was≥8,and 58(70.7%)cases were pathologically staged II-IV.To reduce data bias and confounding factors,71 pairs of comparable cases were obtained after propensity score matching(PSM)based on patient age,BMI,hypertension,diabetes,total prostate-specific antigen(TPSA)value,Gleason score,and surgical modality,with no statistically significant differences between the two groups at baseline.The differences in blood loss,duration of surgery,postoperative hospital stay,positive margins,and urinary incontinence between the two groups were determined using SPSS 26 software.The variation in overall survival rate(OS),progression-free survival ra

关 键 词：前列腺肿瘤 前列腺穿刺活检 前列腺癌根治术 时间间隔 生存分析 并发症 

分 类 号：R737.25[医药卫生—肿瘤]