根治性前列腺切除术后切缘阳性的病理学不良特征对生化复发的影响  

Correlation between pathological features at the positive margin and biochemical recurrence after radical prostatectomy in patients with organ-confined prostate cancer

作　　者：范欣欢 张妍 朱琳琳 刘成益 陈德钢 桑士仿 徐鹏程 FAN Xin-huan;ZHANG Yan;ZHU Lin-lin;LIU Cheng-yi;CHEN De-gang;SANG Shi-fang;XU Peng-cheng(Department of Urology,Affiliated Lu'an Hospital of Anhui Medical University,Lu'an,Anhui 237005,China;Department of Pathology,the First Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou,Zhejiang 310003,China)

机构地区：[1]安徽医科大学附属六安医院泌尿外科,安徽六安237005 [2]浙江大学医学院附属第一医院病理科,浙江杭州310003

出　　处：《中华男科学杂志》2025年第3期202-207,共6页National Journal of Andrology

基　　金：六安市科技计划项目(2022lakj001);浙江省科技重大项目(19ZM06002)。

摘　　要：目的:采用病例对照研究分析切缘阳性的病理学特征对根治性前列腺切除术后生化复发的影响。方法:2014年6月至2019年12月,经病例配对(1∶1)共计有200例行根治性前列腺切除术的器官局限性前列腺癌患者纳入本研究,其中100例患者术后病理证实为切缘阳性,而其余100例患者术后病理证实为切缘阴性,所有患者术前临床分期均为T2/N0,且在术后未经任何形式的辅助治疗。无生化复发生存率采用Kaplan-Meier方法进行估算,各分组间生存期的差异以log-rank方法进行检验。另一方面,预测术后生化复发的切缘阳性病理学特征切线值采用回归树方法进行界定,而各变量与无生化复发生存率之间的相关性采用Cox比例风险回归模型进行估计。结果:200例患者术后病理为pT2期的177例,中位随访时间为32.8(5.6~80.5)个月,术后通过PSA随访发现出现生化复发者共计28例,其中发生于切缘阴性组6例(6.0%),而发生于切缘阳性组22例(22.0%)。通过Kaplan-Meier生存曲线分析,切缘阴性组的未生化复发生存时间长于切缘阳性组的(log-rankχ^(2)=9.336,P=0.003)。进一步通过回归树分析方法,发现切缘阳性组中阳性切缘长度≥1 mm与术后生化复发呈显著的正相关。通过多因素Cox比例风险回归模型分析,发现无论是在总体患者中还是切缘阳性患者中,切缘阳性病灶部位最高Gleason评分≥8分与切缘阳性长度≥1 mm均是术后生化复发的独立影响因素。结论:切缘阳性长度超过1 mm与切缘阳性最高Gleason评分≥8分是根治性前列腺切除术后生化复发的高危因素。Objective:To investigate the correlation between pathological features at the positive margins and biochemical recurrence after radical prostatectomy for prostate cancer.Methods:From June 2014 to December 2019,a total of 200 patients with organ-confined prostate cancer who underwent radical prostatectomy were included in this study by the method of case matching(1∶1).One hundred patients with positive surgical margin and 100 with negative surgical margin were enrolled in this study.All patients did not receive any adjuvant treatment after surgery with a clinical stage of T2/N0.BCR-free survival was estimated using the Kaplan-Meier method.An optimal cutoff for the PSM length which differentiated risk for BCR was identified by Classification and Regression Tree analysis(CART).Cox proportional hazards regression model was used to assess the association between variables and BCR-free survival.Results:A total of 200 patients were included in this study,and 177 patients with pT2 stage were pathological after operation.The median follow-up time of this group of patients was 32.8 months ranged from 5.6 to 80.5 months.A total of 28 cases of biochemical recurrence were found through PSA follow-up after surgery,including 6 cases(6.0%)in the negative margin group and 22 cases(22.0%)in the positive margin group.The result of Kaplan Meier survival curve analysis showed that the non biochemical recurrence survival time of the negative margin group was longer than that of the positive margin group(log rankχ^(2)=9.336,P=0.003).It was found that the length of positive margin≥1 mm in the positive margin group was positively correlated with postoperative biochemical recurrence.Multivariate Cox proportional hazards regression was used to identify that the highest Gleason score≥8 and the length of positive≥1 mm were independent factors of postoperative biochemical recurrence in both the overall patients and the patients with positive margin.Conclusion:The patients with highest Gleason score≥8 and the length of positive≥1m

关 键 词：前列腺癌 根治性前列腺切除术 切缘阳性 病理特征 GLEASON评分 生化复发 

分 类 号：R737.25[医药卫生—肿瘤]