摘要
目的分析根治性前列腺癌切除术切缘阳性的临床病理特征,探讨其影响因素。方法回顾性分析2018年6月至2021年6月北京医院病理科根治性前列腺癌切除术274例患者的临床病理资料。用墨汁涂抹根治性前列腺癌标本切缘,依据癌组织是否侵犯墨汁涂抹标记的切缘分为切缘阳性组、切缘阴性组,比较两组患者的临床病理特征[年龄、术前前列腺特异性抗原(PSA)、病灶数量、病变部位、术后病理Gleason评分、肿瘤负荷、术后病理分期],评价影响切缘阳性的相关危险因素。结果274例标本中,114例切缘阳性,160例切缘阴性,切缘阳性占41.6%。平均年龄68.3岁,切缘阳性组平均年龄68.0岁,切缘阴性组平均年龄68.6岁,差异无统计学意义(P>0.05)。所有病例术前PSA水平均值为15.8μg/L,切缘阳性组为21.5μg/L,切缘阴性组为11.3μg/L,差异具有统计学意义(P<0.001),且随着PSA水平(<10μg/L、10~20μg/L、>20μg/L)的升高,切缘阳性率越高(分别为31.1%、48.7%、69.4%)。病灶数量118例为单灶,其中40例切缘阳性(占33.9%);156例为多灶,其中74例切缘阳性(占47.4%),差异具有统计学意义(P<0.05)。病变部位44例位于移行区、107例位于外周区、123例位于全周,切缘阳性例数分别为12、43、59例,分别占27.3%(12/44)、40.2%(43/107)、48.0%(59/123),差异无统计学意义(P>0.05)。术后Gleason评分3+3=6分51例,3+4=7分98例,4+3=7分81例,≥8分44例,切缘阳性例数分别为10、38、37、29例,分别占19.6%(10/51)、38.8%(38/98)、45.7%(37/81)、65.9%(29/44),差异具有统计学意义(P<0.001)。肿瘤负荷157例<30%,91例为30%~60%,26例>60%,切缘阳性例数分别为33、60及21例,分别占21.0%(33/157)、65.9%(60/91)、80.8%(21/26),差异具有统计学意义(P<0.001)。病理分期181例为T2期,其中53例切缘阳性(占29.3%);93例为T3期,其中61例切缘阳性(占65.6%),差异具有统计学意义(P<0.001)。多因素Logistic回归分析显示切缘阳性组与切缘
Objective To analyze the clinicopathological features of positive surgical margins(PSM)after radical prostatectomy and to explore its associated factors.Method A retrospective analysis was conducted on 274 patients who underwent radical prostatectomy in Beijing Hospital from June 2018 to June 2021.The margins of these specimens of radical prostatectomy were directly inked with black ink.According to the margin status(tumor present versus not),the patients were divided into PSM and negative surgical margin(NSM)groups.The clinicopathological characteristics were compared between two groups,including age,preoperative prostate specific antigen(PSA),number of tumors,tumor′s location,postoperative pathological Gleason score,tumor burden and postoperative pathological staging.Results Among the 274 cases,114 showed PSM,and 160 showed NSM.PSM accounted for 41.6%of the cases.The mean age was 68.3 years,while the PSM group′s mean age was 68.0 years,and that of the NSM group was 68.6 years,with no statistical significance between groups(P>0.05).The mean preoperative PSA was 15.8μg/L in all patients,21.5μg/L in the PSM group and 11.3μg/L in NSM group.PSA in the PSM group was statistically higher than that in the NSM group(P<0.001).The PSA level(10μg/L,10-20μg/L,and>20μg/L)was associated with the PSM rate(31.1%,48.7%,and 69.4%).Regarding tumor numbers,118 cases had a single focus,including 40 cases with PSM(33.9%).In the 156 cases of multiple foci,74 cases had a PSM(47.4%).There were statistically more PSM cases in the cases with multi-focal disease(P<0.05).Tumors were seen in the transit zone of 44 cases,while 107 cases showed tumors in the peripheral zone,and 123 cases in the whole zone.The PSM rate was 27.3%(12/44),40.2%(43/107),and 48.0%(59/123)by tumor location,respectively,but the difference among groups was not statistically significant(P>0.05).The postoperative Gleason scores were 3+3=6 in 51 cases,3+4=7 in 98 cases,4+3=7 in 81 cases,and≥8 in 44 cases,with PSM rates of 19.6%(10/51),38.8%(38/98),45.7%(37/81)
作者
刘龙腾
崔娣
王淼
刘明
刘东戈
张伟
Liu Longteng;Cui Di;Wang Miao;Liu Ming(Department of Pathology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Urology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中华病理学杂志》
CAS
CSCD
北大核心
2022年第7期627-633,共7页
Chinese Journal of Pathology
基金
中国医学科学院医学与健康科技创新工程(2018-I2M-1-002)
白求恩·泌尿肿瘤专项研究基金项目(mnzl202024)。
