摘要
目的探讨淋巴血管侵犯(LVI)对根治性前列腺切除术(RP)后生化复发的影响。方法回顾性分析2012年6月至2020年11月天津医科大学第二医院收治的403例RP患者的临床资料。中位年龄67(47~81)岁;前列腺特异性抗原(PSA)中位值18.0(1.9~813.0)ng/ml。穿刺病理Gleason评分6分44例(10.9%),3+4分65例(16.1%),4+3分62例(15.4%),≥8分232例(57.5%)。其中73例(18.1%)接受新辅助内分泌治疗。403例均行RP+盆腔淋巴结清扫术,其中10例行开放手术,144例行腹腔镜手术,249例行机器人辅助腹腔镜手术。采用χ^(2)检验分析LVI与临床病理因素的关系,绘制Kaplan-Meier曲线并用log-rank检验比较LVI阳性与阴性患者的无生化复发生存期,采用Cox风险比例模型进行单因素及多因素分析。结果403例中,根治标本Gleason评分≤6分68例(16.9%),3+4分87例(21.6%),4+3分89例(22.1%),≥8分159例(39.5%);切缘阳性179例(44.4%);精囊侵犯95例(23.6%);病理分期T_(1-2)期167例(41.4%),T_(3-4)期236例(58.6%);淋巴结阳性39例(9.7%);LVI阳性62例(15.4%),LVI阴性341例(84.6%)。LVI阳性与阴性患者的穿刺Gleason评分、根治标本Gleason评分、病理分期、精囊侵犯率、淋巴结阳性率差异均有统计学意义(P<0.05)。术后259例(64.3%)行辅助内分泌治疗,70例(17.4%)行辅助放疗联合内分泌治疗。所有患者中位随访时间22(6~89)个月。截至末次随访,LVI阳性患者中23例(37.1%)出现生化复发,中位无生化复发生存期41个月;LVI阴性患者71例(20.8%)出现生化复发,中位无生化复发生存期尚未达到,与LVI阳性患者差异有统计学意义(P<0.001)。Cox多因素回归分析结果显示,PSA水平、穿刺Gleason评分、接受新辅助内分泌治疗、病理分期、切缘阳性、精囊侵犯、淋巴结转移和LVI是RP术后生化复发的独立影响因素(均P<0.05)。结论LVI伴有更高的穿刺和根治标本Gleason评分、病理分期、精囊侵犯率、淋巴结阳性率,LVI预示着更短的无生化复
Objective To investigate the effect of lymphovascular invasion(LVI)on biochemical recurrence in patients treated with radical prostatectomy(RP).Methods From June 2012 to November 2020,403 cases treated with RP in the Second Hospital of Tianjin Medical University were analyzed retrospectively.Median age was 67(range 47-81)years old.Median prostate specific antigen(PSA)was 18.0(range 1.9-813.0)ng/ml.All patients received prostate biopsy and were confirmed with prostatic acinar adenocarcinoma according to pathology.The Gleason score of 44(10.9%)cases were 6,65(16.1%)cases were 3+4,62(15.4%)cases were 4+3,and 232(57.5%)cases were≥8.73(18.1%)patients received neoadjuvant hormonal therapy.RP and pelvic lymph node dissection were carried out in all patients including 10 open surgery,144 laparoscopic surgery and 249 robot-assisted laparoscopic surgery.Theχ^(2) test was used to analyze the correlation between LVI and clinicopathological characteristics.Kaplan-Meier method and log-rank test were used to summarize time-to-biochemical recurrence end point and compare biochemical recurrence-free survival between LVI positive and negative groups.Univariable and multivariable analyses were performed to test the possible factors of biochemical recurrence with Cox proportional-hazard model.Results Of all 403 patients treated with RP,the final Gleason score of 68(16.9%)cases were≤6,87(21.6%)cases were 3+4,89(22.1%)cases were 4+3,and 159(39.5%)cases were≥8.179(44.4%)patients had positive surgical margins.The rate of seminal vesicle invasion was 23.6%(95 patients).There were 167(41.4%)cases with T_(1-2) and 236(58.6%)cases with T_(3-4) pathological stage.39(9.7%)patients had lymph node metastasis.62(15.4%)patients were LVI positive and 341(84.6%)patients were LVI negative.There were statistically significant differences in biopsy and final Gleason score,pathological stage,rates of seminal vesicle invasion and rates of positive lymph node between LVI positive and negative patients(P<0.05).259(64.3%)patients received adjuvant h
作者
马申飞
常泰浩
张洪团
王晓明
刘冉录
徐勇
Ma Shenfei;Chang Taihao;Zhang Hongtuan;Wang Xiaoming;Liu Ranlu;Xu Yong(Department of Urology,Tianjin Institute of Urology,the Second Hospital of Tianjin Medical University,Tianjin 300000,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2022年第5期379-383,共5页
Chinese Journal of Urology
关键词
前列腺肿瘤
癌
根治性前列腺切除术
淋巴血管侵犯
生化复发
Prostatic neoplasms
Carcinoma
Radical prostatectomy
Lymphovascular invasion
Biochemical recurrence
