机器人辅助根治性前列腺切除术后前列腺包膜外侵犯的预测因素分析(附手术视频)  

Predictive factors of extraprostatic extension after robot-assisted radical prostatectomy(with surgical video)

作　　者：曾一鸣 李远伟[1] 李宗霖 彭贵重 贺显雅 杨勇军 卢强[1] 李丹[2] 刘宇[3] ZENG Yiming;LI Yuanwei;LI Zonglin;PENG Guizhong;HE Xianya;YANG Yongjun;LU Qiang;LI Dan;LIU Yu(Department of Urology;Department of Radiology;Department of Pathology,Hunan Provincial People’s Hospital,Changsha 410000,China)

机构地区：[1]湖南省人民医院泌尿外科,湖南长沙410000 [2]湖南省人民医院放射科,湖南长沙410000 [3]湖南省人民医院病理科,湖南长沙410000

出　　处：《机器人外科学杂志（中英文）》2024年第4期516-520,共5页Chinese Journal of Robotic Surgery

基　　金：湖南省卫生健康委2023年度科研计划项目(D202304057410)。

摘　　要：目的:回顾性分析机器人辅助根治性前列腺切除术后发生前列腺包膜外侵犯(EPE)的危险因素,以指导治疗方案决策。方法:回顾性分析2019年3月—2022年12月于湖南省人民医院行机器人辅助根治性前列腺切除术(RARP)患者的临床资料,收集患者年龄、前列腺特异性抗原(PSA)、前列腺体积(PV)、前列腺成像报告和数据系统(PI-RADS)、穿刺最高累及百分比、前列腺穿刺Gleason评分及RARP术后病理结果等,采用单因素和多因素Logistic回归分析RARP术后病理包膜外侵犯的危险因素,并运用ROC曲线比较各危险因素的预测价值。结果:本研究共纳入55例符合条件者,RARP术后病理提示前列腺包膜外侵犯共33例(60%)。单因素分析显示年龄、PI-RADS评分、穿刺Gleason评分、穿刺神经侵犯、穿刺最高累及百分比与RARP术后发生包膜外侵犯有显著关系(P<0.05),多因素分析显示PSA、PI-RADS、穿刺Gleason评分、穿刺最高累及百分比是RARP术后发生包膜外侵犯的独立危险因素(P<0.05),AUC值分别为0.57、0.67、0.83、0.84;PI-RADS、穿刺Gleason评分、穿刺最高累及百分比三组联合时对EPE的预测价值最高:AUC=0.861,灵敏度0.61,特异性0.96。结论:PSA、PIRADS、穿刺最高累及百分比、穿刺Gleason评分是RARP术后发生EPE的独立危险因素,综合分析PI-RADS、穿刺Gleason评分和穿刺最高累及百分比能提高对EPE预测的准确性。Objective:To retrospectively explore the risk factors of extraprostatic extension(EPE)after robot-assisted radical prostatectomy(RARP)to guide treatment decision making.Methods:Clinical data of patients who underwent RARP in Hunan Provincial People’s Hospital from March 2019 to December 2022 were collected,including patient age,prostate-specific antigen(PSA),prostate volume(PV),prostate imaging-reporting and data system(PI-RADS),tumor percentage of the highest biopsy score,Gleason score of prostate biopsy,and pathological results after radical prostatectomy.Univariate and multivariate Logistic regression analyses were conducted to identify risk factors for extraprostatic extension after RARP.Receiver operating characteristic(ROC)curve analysis was used to compare the predictive values of each risk factor.Results:A total of 55 patients were included in the study,33 cases of EPE occurred after RARP.Univariate analysis results showed a significant relation between age,PI-RADS score,biopsy Gleason score,perineural invasion in biopsy,the tumor percentage of the highest biopsy score,and the presence of EPR after RARP(P<0.05).Multivariate analysis indicated that PSA,PI-RADS,biopsy Gleason score,and the tumor percentage of the highest biopsy score were independent risk factors for EPR after RARP.The AUC values of the above four risk factors were 0.57,0.67,0.83,and 0.84,respectively.The highest predictive value(AUC=0.861)for EPE was achieved when the three factors(PI-RADS,biopsy Gleason score,and tumor percentage of the highest biopsy score)combined,with a sensitivity of 0.61 and specificity of 0.96.Conclusion:The PI-RADS,PSA level,tumor percentage of the highest biopsy score,and biopsy Gleason score are independent risk factors for ECE,and comprehensive analysis of PI-RADS,biopsy Gleason score and the tumor percentage of the highest biopsy score can improve the predictive accuracy of ECE.

关 键 词：机器人辅助手术 根治性前列腺切除术 包膜外侵犯 预测 

分 类 号：R608[医药卫生—外科学] R737.25[医药卫生—临床医学]