扩大盆腔淋巴结清扫术对中高危前列腺癌患者预后的影响  

Effect of extend ednode pelvic lymph dissection on postoperative prognosis of middle and high risk prostate cancer patients

作　　者：杨帮东[1] 刘瑞强[1] 史建华[1] 杨超 Yang Bangdong;Liu Ruiqiang;Shi Jianhua;Yang Chao(Department of Urology,Puyang People's Hospital,Puyang 457000,China;Department of Urology,Anyang People's Hospital,Anyang 455002,China)

机构地区：[1]濮阳市人民医院泌尿外科,河南濮阳457000 [2]安阳市人民医院泌尿外科,河南安阳455002

出　　处：《安徽医学》2024年第4期463-468,共6页Anhui Medical Journal

摘　　要：目的评估扩大盆腔淋巴结清扫术(ePLND)对接受根治性前列腺切除术(RP)治疗的中高风险前列腺癌(PCa)患者预后的影响。方法选择2010年5月至2020年12月在濮阳市人民医院(1309例)和安阳市人民医院(1163例)进行RP治疗的PCa患者2472例。根据PCa患者是否行ePLND,将其分为ePLND组(2283例)和非ePLND组(189例)。其中ePLND组患者2283例,非ePLND组189例。患者随访时间为(13~107)个月,中位随访时间为56(24,72)个月。对比分析两组患者的术后生存状况。结果⑴术后5年:生化复发(BCR)率为60.80%,远处转移率41.22%,肿瘤特异性生存率(CSS)率为94.78%,总生存率为84.34。⑵是否进行ePLND对上述术后5年生存率的4个结局指标均无影响(P>0.05);⑶Cox回归显示,对PCa患者术后5年各结局指标而言:①Glea⁃son评分、肿瘤临床分期、术前血清PSA、穿刺活检针数阳性率、精囊侵犯是BCR的危险因素(P<0.05);②Gleason评分、肿瘤病理分期、肿瘤临床分期、术后切缘阳性、穿刺活检针数阳性率是远处转移的危险因素(P<0.05);③年龄、术前血清PSA、Gleason评分、肿瘤病理分期、肿瘤临床分期、术后切缘阳性、穿刺活检针数阳性率是肿瘤特异性生存CSS的危险因素(P<0.05)。④年龄、术前血清PSA、Gleason评分、肿瘤病理分期、肿瘤临床分期、穿刺活检针数阳性率是影响OS的危险因素(P<0.05)。结论在进行前列腺根治手术的中高危PCa患者中,ePLND对患者预后无显著影响。Objective To evaluate the impact of extended pelvic lymph node dissection(ePLND)on the prognosis of patients with me⁃dium to high-risk prostate cancer(PCa)undergoing prostetectomy(RP).Methods A total of 2472 PCa patients who underwent RP treatment at Puyang People’s Hospital(1309 cases)and Anyang People’s Hospital(1163 cases)from May 2010 to December 2020 were recruited.PCa patients were divided into the ePLND group and non ePLND group based on whether they underwent ePLND.Among them,there were 2283 patients in the ePLND group and 189 patients in the non ePLND group.The postoperative survival status of two groups of patients were com⁃pared and analyzed.The patients was followed up for(13~107)months,with a median follow-up time of 56(24,72)months.Results⑴Five years after surgery:The BCR rate was 60.80%,the distant metastasis rate was 41.22%,the CSS rate was 94.78%,and the overall survival rate was 84.34.⑵Whether ePLND was performed or not had no effect on the four outcome indicators of the 5-year survival rate(P>0.05);(3)COX regression showed that for PCa patients at 5 years after surgery,various outcome indicators were:①Gleason score,tumor clinical stage,preop⁃erative serum PSA,positive rate of biopsy needle count,and seminal vesicle invasion were risk factors for BCR(P<0.05);②Gleason score,tu⁃mor pathological staging,tumor clinical staging,positive postoperative margin,and positive number of biopsy needles were risk factors for dis⁃tant metastasis(P<0.05);③Age,preoperative serum PSA,Gleason score,tumor pathological staging,tumor clinical staging,positive postopera⁃tive margin,and positive biopsy needle count were risk factors for tumor specific survival of CSS(P<0.05);④Age,preoperative serum PSA,Gleason score,tumor pathological staging,tumor clinical staging,and positive rate of biopsy needle count were risk factors affecting OS(P<0.05).Conclusion Among medium to high-risk PCa patients undergoing RP,whether ePLND is performed or not has no significant impact on their prognosis.

关 键 词：扩大盆腔淋巴结清扫术 前列腺癌 预后 

分 类 号：R737.25[医药卫生—肿瘤]