腹腔镜前列腺癌根治性切除术后患者生化复发的预测因素  

Predictive factors for biochemical recurrence after laparoscopic radical prostatectomy in patients with prostate cancer

作　　者：赵勇 戚宇 王杭 姜帅 施国洪 张旭 郭剑明 徐磊 ZHAO Yong;QI Yu;WANG Hang;JIANG Shuai;SHI Guo-hong;ZHANG Xu;GUO Jian-ming;XU Lei(Department of Urology,First Hospital of Nanping City,Fujian Medical University,Nanping 353000,Fujian Province,China;Department of Urology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]福建省医科大学附属南平第一医院泌尿外科,南平353000 [2]复旦大学附属中山医院泌尿外科,上海200032

出　　处：《复旦学报（医学版）》2024年第4期494-504,共11页Fudan University Journal of Medical Sciences

基　　金：福建省自然科学基金项目(2023J011873)。

摘　　要：目的预测腹腔镜前列腺癌根治性切除术后患者生化复发的主要因素。方法选取2016年1月至2018年6月在复旦大学附属中山医院泌尿外科接受腹腔镜前列腺癌根治性切除术的前列腺癌患者416例。在发生生化复发之前,没有患者接受辅助治疗。单因素和多因素Cox比例风险回归模型用于确定预测生化复发的变量,采用Kaplan-Meier方法评估无生化复发生存率。结果本研究中位随访时间为174(133~209)周。整个队列的生化复发率为21.15%(88/416),生化复发的时间为(51.11±47.71)周。至随访结束,低危、中危、高危、局部进展至随访结束复发率分别为:10%(1/10)、6.12%(3/49)、16.41%(43/262)、43.16%(41/95)。预测生化复发的多变量Cox比例风险回归模型的数据显示,肿瘤侵犯包膜(HR:2.119,95%CI:1.154~3.891,P=0.016)、肿瘤侵犯精囊(HR:1.824,95%CI:1.034~3.220,P=0.038)、GS评分≥8(HR:2.746,95%CI:1.268~5.943,P=0.010)、前列腺特异性抗原(prostate-specific antigen,PSA)=10~20 ng/mL(HR:4.240,95%CI:2.550~7.050,P<0.001)、PSA>20 ng/mL(HR:6.341,95%CI:3.296~12.202,P<0.001)是预测生化复发的主要因素。结论腹腔镜前列腺癌根治性切除术在中期随访期间可有效控制生化复发。肿瘤侵犯包膜、肿瘤侵犯精囊、GS评分≥8、PSA=10~20 ng/mL、PSA>20 ng/mL是预测生化复发的主要因素。Objective To evaluate the predictors of biochemical recurrence after laparoscopic radical prostatectomy.Methods The study cohort consisted of 416 consecutive prostatecancer patients who underwent radical prostatectomy in Zhongshan Hospital,Fudan University between Jan 2016 and Jun 2018.No patient received adjuvant therapy until documented biochemical recurrence.Biochemical recurrence-free survival(BCRFS)was estimated using the Kaplan-Meier method.Univariable and multivariable Cox proportional hazards regression models were utilized to determine variables predictive of biochemical recurrence.Results The median follow-up period was 174 weeks(inter quartile range 133-209 weeks).The overall biochemical recurrence rate was 21.39%(88/416).The time to biochemical recurrence was(51.11±47.71)weeks.Until the end of follow-up,the biochemical recurrence rates were 10%(1/10),6.12%(3/49),16.41%(43/262)and 43.16%(41/95)for low-risk,medium-risk,high-risk and locally advanced prostate cancer,respectively.On multivariable analysis,tumor invasion of the seminal vesicles(HR:2.119,95%CI:1.154-3.891,P=0.016);Seminal vesicle invasion(HR:1.824,95%CI:1.034-3.220,P=0.038),Gleason score≥8(HR:2.746,95%CI:1.268-5.943,P=0.010),prostate-specific antigen(PSA)=10-20 ng/mL(HR:4.240,95%CI:2.550-7.050,P<0.001);PSA>20 ng/mL(HR:6.341,95%CI:3.296-12.202,P<0.001)were the main predictors of biochemical recurrence.Conclusion Laparoscopic radical prostatectomy provides effective control of biochemical recurrence during the mid-term follow-up period.Tumor invasion of the seminal vesicles,seminal vesicle invasion,GS≥8,PSA=10-20 ng/mL,PSA>20 ng/mL were important predictors of biochemical recurrence after radical prostatectomy.

关 键 词：腹腔镜 根治性前列腺切除术(RP) 生化复发(BCR) 前列腺癌 

分 类 号：R737.25[医药卫生—肿瘤]