摘要
目的探讨不同前列腺癌精囊受侵影像分型对腹腔镜根治性前列腺切除术后切缘阳性的影响。方法回顾性分析2009年8月至2020年12月北京大学第三医院收治的114例pT3b期前列腺癌患者的临床资料。患者年龄(68.2±7.7)岁,穿刺前中位前列腺特异性抗原(PSA)为20.20(3.45~186.30)ng/ml,穿刺Gleason评分≤7、≥8分者分别为33例(28.9%)、81例(71.1%),前列腺体积中位值为33.2(12.1~155.4)ml。由放射科高年资前列腺肿瘤专业影像医生根据前列腺癌精囊侵犯影像表现分为以下类型:Ⅰ型,肿瘤直接沿输精管侵犯精囊;Ⅱa型,肿瘤侵犯前列腺基底部包膜并侵犯精囊;Ⅱb型,肿瘤侵犯前列腺周围脂肪并逆行侵犯精囊;Ⅲ型:精囊内孤立病灶且不与前列腺肿瘤延续。所有患者均行腹腔镜根治性前列腺切除术。比较不同精囊受侵影像分型患者临床病理资料的差异;将单因素分析中P<0.1的指标纳入多因素logistic回归,分析pT3b期前列腺癌切缘阳性的独立危险因素。结果本组114例手术时间(229.4±62.2)min,出血量100(20~1800)ml。术后大体病理Gleason评分≤7分17例,≥8分97例;切缘阳性56例(49.1%)。前列腺癌精囊受侵影像分型中,Ⅰ型28例(24.6%),Ⅱa型39例(34.2%),Ⅱb型47例(41.2%),无Ⅲ型患者。Ⅰ、Ⅱa、Ⅱb型精囊受侵患者的年龄、体质指数、穿刺前PSA、前列腺体积、手术时间差异均无统计学意义(P>0.05);3种类型患者术中出血量差异有统计学意义[50(20~600)ml与100(20~1000)ml与150(20~1800)ml,P=0.001],病理淋巴结转移比例差异有统计学意义[3例(10.7%)与4例(9.1%)与14例(27.9%),P=0.013]。Ⅰ、Ⅱa、Ⅱb型切缘阳性率分别为28.6%(8/28)、38.5%(15/39)和70.2%(33/47),差异有统计学意义(P=0.001)。将切缘阳性的单因素分析中穿刺Gleason评分(P=0.063)和精囊受侵分型(P<0.001)纳入多因素logistic回归分析,结果显示精囊受侵分型(P=0.001)是pT3b期前列腺癌腹腔镜根治性前列腺切除术
Objective To investigate the effect of different imaging classifications of prostate cancer seminal vesicle invasion on positive surgical margins(PSM)after laparoscopic radical prostatectomy(LRP).Methods 114 patients with pT3b stage prostate cancer admitted to Peking University Third Hospital from August 2009 to December 2020 were retrospectively analyzed.The age of the patients was(68.2±7.7)years old,the median pre-biopsy PSA was 20.20(3.45-186.30)ng/ml,and the patients with biopsy Gleason score of≤7,and≥8 was 33 and 81 cases,respectively.The median prostate volume was 33.2(12.1-155.4)ml.According to the imaging of the seminal vesicle invasion of prostate cancer,the patients were divided into the following types:typeⅠ,the tumor directly invades the seminal vesicle along the vas deferens;typeⅡa,the tumor invades the basal capsule of the prostate and invades the seminal vesicle;typeⅡb,the tumor invades the periprostatic fat and retrogradely invades the seminal vesicles;typeⅢ,solitary lesions in the seminal vesicles that do not continue with the prostate cancer.All patients underwent LRP,and the PSM were recorded as the base,bilateral,posterior,anterior and apical parts of the prostate.The differences in clinicopathological data of patients with different seminal vesicle invasion imaging types were compared,and the independent risk factors of PSM in pT3b prostate cancer were evaluated by multivariate analysis.Results The operative time of 114 cases in this group was(229.4±62.2)min,and the blood loss was 100(20-1800)ml.The postoperative gross pathological Gleason score was≤7 in 17 cases and≥8 in 97 cases.In the imaging classification of prostate cancer with seminal vesicle invasion,there were 28 cases(24.6%)of typeⅠ,39 cases(34.2%)of typeⅡa,47 cases(41.2%)of typeⅡb,and no typeⅢpatients.There was no significant difference in age,body mass index,pre-biopsy PSA,prostate volume,and operation time among patients with typeⅠ,Ⅱa,andⅡb seminal vesicle invasion(P>0.05).There was a statistically
作者
张帆
裴新龙
颜野
陆敏
刘承
张树栋
黄毅
马潞林
Zhang Fan;Pei Xinlong;Yan Ye;Lu Min;Liu Cheng;Zhang Shudong;Huang Yi;Ma Lulin(Department of Urology,Peking University Third Hospital,Beijing 100191,China;Department of Radiology,Peking University Third Hospital,Beijing 100191,China;Department of Pathology,Peking University Health Science Centre,Beijing 100183,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2022年第7期523-528,共6页
Chinese Journal of Urology
关键词
前列腺肿瘤
癌
精囊侵犯
切缘阳性
前列腺切除术
Prostatic neoplasms
Carcinoma
Seminal vesicle invasion
Surgical margin
Prostatectomy
