根治性前列腺切除术后切缘阳性的影响因素分析  

Influencing factors of positive surgical margins after radical resection of prostate cancer

作　　者：时昌杰 任志健 张莹 吴鼎 房波 石秀全 程文 傅点 徐晓峰 SHI Chang-jie;REN Zhi-jian;ZHANG Ying;WU Ding;FANG Bo;SHI Xiu-quan;CHENG Wen;FU Dian;XU Xiao-feng(Department of Urology,General Hospital of Eastern Theater Command,Nanjing,Jiangsu 210002,China;Department of Urology,the First Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215006,China)

机构地区：[1]东部战区总医院泌尿外科,江苏南京210002 [2]苏州大学附属第一医院泌尿外科,江苏苏州215006

出　　处：《中华男科学杂志》2025年第4期328-332,共5页National Journal of Andrology

摘　　要：目的:探讨根治性前列腺切除术治疗方案对患者病理切缘阳性的影响。方法:回顾性分析2011年至2020年于东部战区总医院行根治性前列腺切除术治疗的407例患者的临床资料,根据术后病理结果分为切缘阳性和切缘阴性两组。采用单因素分析评估患者术后Gleason评分、术前总前列腺特异性抗原(tPSA)、fPSA/tPSA、临床T分期、术后病理pT分期、是否机器人手术、年龄、体质量指数(BMI),前列腺肿瘤左右径、上下径、前后径及体积对术后切缘阳性的影响,采用多因素logistic回归进一步分析术后切缘阳性的独立危险因素。结果:407例前列腺癌术后患者中切缘阳性组179例(43.98%),术后切缘阴性组228例(56.02%)。单因素分析结果表明,术后Gleason评分、术前tPSA、临床T分期、术后病理pT分期是术后切缘阳性的相关因素(P<0.05),其中术后Gleason评分、术前tPSA、术后病理pT分期是术后切缘阳性的独立危险因素。结论:术后Gleason评分、术前tPSA、临床T分期、术后病理pT分期与前列腺癌术后切缘阳性发生率存在联系。其中术后Gleason评分(Gleason=7分、Gleason≥8分)、术前tPSA>20μg/L、术后病理pT分期(pT3a、pT3b)是前列腺癌术后病理切缘阳性的独立危险因素。Objective:To investigate the influencing factors of pathological positive surgical margins(PSM)after radical resection of prostate cancer.Methods:The clinical data of 407 patients who underwent radical resection of prostate cancer in our hospital from 2011 to 2020 were retrospectively analyzed.And the patients were divided into two groups according to postoperative pathological results.Single factor analysis was used to evaluate the differences in postoperative Gleason score,preoperative total prostate-specific antigen(tPSA),preoperative serum free prostate-specific antigen to preoperative tPSA ratio(fPSA/tPSA),clinical stage,postoperative pathological stage,operation method,age,body mass index(BMI),diameter and volume of prostate tumor.Multivariate logistic regression was used to determine the independent risk factor of PSM.Results:Among 407 patients with prostate cancer,179 cases(43.98%)were positive.Univariate analysis showed that there were significant differences in postoperative Gleason score,preoperative tPSA,clinical stage and postoperative pathological stage between the two groups(P<0.05).And Gleason score,preoperative tPSA and pathologic stage were independent risk factors for PSM.Conclusion:There are relationships between PSM and postoperative Gleason score,tPSA,clinical T stage,postoperative pathologic pT stage.Among them,postoperative Gleason score(Gleason=7 points,Gleason≥8 points),preoperative total prostate-specific antigen(tPSA>20μg/L),and postoperative pathologic pT stage(pT3a,pT3b)were independent risk factors for positive pathological margins of prostate cancer.

关 键 词：根治性前列腺切除术 GLEASON评分 前列腺特异性抗原 病理分期 切缘阳性 

分 类 号：R737.25[医药卫生—肿瘤]