前列腺前脂肪垫淋巴结转移阳性与机器人根治性前列腺切除术预后关系研究  

Lymph node metastasis in the prostatic anterior fat pad and prognosis after robot-assisted radical prostatectomy

作　　者：叶洲杰 宋勇[2] 邵金鹏 陈文政[2] 杨国强[2] 杜青山[2] 刘侃[2] 朱捷[2] 王保军[2] 高江平[2] 符伟军[2] YE Zhou-jie;SONG Yong;SHAO Jin-peng;CHEN Wen-zheng;YANG Guo-qiang;DU Qing-shan;LIU Kan;ZHU Jie;WANG Bao-jun;GAO Jiang-ping;FU Wei-jun(Nankai University School of Medicine,Tianjin 300071,China;Senior Department of Urology,PLA General Hospital,Beijing 100039,China;Chinese PLA Medical School,Beijing 100853,China)

机构地区：[1]南开大学医学院,天津300071 [2]解放军总医院泌尿外科医学部,北京100039 [3]解放军医学院,北京100853

出　　处：《中华男科学杂志》2025年第3期216-221,共6页National Journal of Andrology

摘　　要：目的:探究机器人根治性前列腺切除术(RARP)患者的前列腺前脂肪垫(PAFP)中淋巴结转移情况,分析PAFP淋巴结阳性转移患者的临床、病理特征及预后差异。方法:回顾性分析2017年1月至2022年12月解放军总医院泌尿外科医学部接受RARP患者1003例的临床和病理学资料。所有患者在RARP中常规切除PAFP并单独行病理学检查,所有PAFP病理标本均经病理专科医师阅片报告。按PAFP中有无淋巴结阳性转移、淋巴结阳性转移部位进行分组统计分析。临床病理特征比较采用t检验、Mann-Whitney U检验和χ2检验,采用Kaplan-Meier法和Log-rank法进行生存分析,采用R4.4.1软件绘制生存曲线。结果:77例患者的PAFP标本中检出淋巴结,检出率7.7%(77/1003),其中PAFP淋巴结阳性转移患者11例,阳性率14.3%(11/77),淋巴结阳性检出率1.1%(11/1003),9例患者因PAFP发生淋巴结阳性转移导致病理学N分期升级,余2例合并有盆腔淋巴结阳性转移。PAFP淋巴结阳性转移患者术后病理学T分期≥T3的比例[81.8%(9/11)vs 36.2%(359/992),P=0.005]及病理GS评分≥8分的比例[87.5%(7/8)vs 35.5%(279/786),P=0.009]显著高于未发生PAFP淋巴结阳性转移患者。单纯PAFP与单纯盆腔淋巴结阳性转移组比较,两组临床、病理特征及无生化复发生存期均无显著差异。结论:PAFP是淋巴转移的可行途径,PAFP淋巴结阳性转移患者的病理特征更差,单纯PAFP与单纯盆腔淋巴结阳性转移患者无生化复发生存期无显著差异,RARP术中常规切除PAFP并进行单独病理学检查有重要临床意义。Objective:To investigate lymph node metastasis(LNM)in the prostatic anterior fat pad(PAFP)of PCa patients after robot-assisted radical prostatectomy(RARP),and analyze the clinicopathological features and prognosis of LNM in the PAFP.Methods:We retrospectively analyzed the clinicopathological data on 1003 cases of PCa treated by RARP in the Department of Urology of PLA General Hospital from January 2017 to December 2022.All the patients underwent routine removal of the PAFP during RARP and pathological examination,with the results of all the specimens examined and reported by pathologists.Based on the presence and locations of LNM,we grouped the patients for statistical analysis,compared the clinicopathological features between different groups using the Student's t,Mann-Whitney U and Chi-square tests,and conducted survival analyses using the Kaplan-Meier and Log-rank methods and survival curves generated by Rstudio.Results:Lymph nodes were detected in 77(7.7%)of the 1003 PAFP samples,and LNM in 11(14.3%)of the 77 cases,with a positive rate of 1.1%(11/1003).Of the 11 positive cases,9 were found in the upgraded pathological N stage,and the other 2 complicated by pelvic LNM.The patients with postoperative pathological stage≥T3 constituted a significantly higher proportion in the PAFP LNM than in the non-PAFP LNM group(81.8%[9/11]vs 36.2%[359/992],P=0.005),and so did the cases with Gleason score≥8(87.5%[7/8]vs 35.5%[279/786],P=0.009).No statistically significant differences were observed in the clinicopathological features and biochemical recurrence-free survival between the patients with PAFP LNM only and those with pelvic LNM only.Conclusion:The PAFP is a potential route to LNM,and patients with LNM in the PAFP are characterized by poor pathological features.There is no statistically significant difference in biochemical recurrence-free survival between the patients with PAFP LNM only and those with pelvic LNM only.Routine removal of the PAFP and independent pathological examination of the specimen during RARP

关 键 词：前列腺癌 机器人根治性前列腺切除术 淋巴结转移 前列腺前脂肪垫 生化复发 

分 类 号：R737.25[医药卫生—肿瘤]