-
摘要:
目的 探究影响腹腔镜前列腺癌根治术（laparoscopic radical prostatectomy，LRP）后切缘阳性（positive surgical margin，PSM）的相关因素。 方法 回顾性分析2016年1月至2017年12月177例于北京大学第一医院行LRP患者的临床资料，将患者分为术后PSM和切缘阴性组，分析各组不同的年龄、前列腺体积、穿刺前血清前列腺特异性抗原（prostate-specific antigen，PSA）值、穿刺阳性针数及其百分比、穿刺及术后病理的Gleason评分和术后病理T分期对术后切缘的影响。 结果 177例患者中，患者术后PSM的阳性率为32.2%（57/177）。患者年龄、前列腺体积、穿刺前血清PSA值、穿刺及术后病理的Gleason评分与术后PSM之间无显著相关性（P>0.05）。穿刺阳性针数及其百分比、术后病理不同T分期的术后PSM与切缘阴性进行比较，差异具有统计学意义（P＜0.05）。多因素Logistic回归模型分析显示，术后病理T分期是PSM的独立危险因素（OR为1.616，95%CI为1.062~2.459，P＜0.05）。 结论 LRP后PSM与前列腺穿刺阳性针数及其百分比、术后病理T分期之间具有相关性，且术后病理T分期是其独立危险因素。 Abstract:Objective To identify risk factors for positive surgical margin after laparoscopic radical prostatectomy. Method The study retrospectively analyzed the records of 177 patients with prostate cancer who eventually underwent laparoscopic radical prostatectomy from January 2016 to December 2017 in Peking University First Hospital. Age, prostate volume, prostate-specific antigen (PSA) before needle biopsy, number of positive cores, positive percentage of needle biopsy and biopsy, and postoperative Gleason scoreand pathological stage were analyzed. Results The overall positive surgical margin rate was 32.2% (57/177). Age, prostate volume, PSA before needle biopsy, positive percentage of biopsy, and postoperative Gleason score were not significantly different (P>0.05). The study demonstrated significant differences between the number of positive cores, positive percentage of needle biopsy, and pathological stage (P < 0.05). Multiple logistic regression revealed that the pathological stage was an independent factor affecting the positive surgical margin rate (odds ratio, 1.616; 95% confidence interval, 1.062-2.459). Conclusions The number of positive cores, positive percentage of needle biopsy, and pathological stage significantly correlated with a positive surgical margin. The postoperative pathological T stage is an independent factor affecting positive surgical margins. -
Key words:
- prostate cancer /
- positive surgical margin /
- laparoscopy /
- prostatectomy
-
表 1 177例前列腺癌患者的临床资料
表 2 多因素Logistic回归模型分析术后PSM的独立危险因素
-
[1] Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018[J]. CA Cancer J Clin, 2018, 68(1):7-30. http://d.old.wanfangdata.com.cn/Periodical/zhjzcjbdzzz201802002 [2] 叶定伟, 朱耀.中国前列腺癌的流行病学概述和启示[J].中华外科杂志, 2015, 53(4):249-252. doi: 10.3760/cma.j.issn.0529-5815.2015.04.003 [3] Yang R, Cao K, Han T, et al. Perineural invasion status, Gleason score and number of positive cores in biopsy pathology are predictors of positive surgical margin following laparoscopic radical prostatectomy[J]. Asian J Androl, 2017, 19(4):468-472. http://cn.bing.com/academic/profile?id=a71acbfb4252d79e6749dfe816911e41&encoded=0&v=paper_preview&mkt=zh-cn [4] 吴阶平.吴阶平泌尿外科学[M].山东:山东科学技术出版社, 2009. [5] Choo MS, Cho SY, Jeong CW, et al. Predictors of positive surgical margins and their location in Korean men undergoing radical prostatectomy[J]. Int J Urol, 2014, 21(9):894-898. doi: 10.1111/iju.2014.21.issue-9 [6] Labanaris AP, Zugor V, Witt JH. Robot-assisted radical prostatectomy in patients with a pathologic prostate specimen weight ≥100 grams versus ≤50 grams: surgical, oncologic and short-term functional outcomes[J]. Urol Int, 2013, 90(1):24-30. http://cn.bing.com/academic/profile?id=3a21aa1a02ce073e2aea1aa11913916b&encoded=0&v=paper_preview&mkt=zh-cn [7] 宋伟, 赵勇, 金讯波, 等.经腹腔途径腹腔镜前列腺癌根治术后切缘阳性的影响因素分析[J].泌尿外科杂志(电子版), 2015, 7(4):24-26. http://d.old.wanfangdata.com.cn/Periodical/mnwkzz201504006 [8] Brureau L, Emeville E, Multigner L, et al. Predictors of biochemical recurrence after radical prostatectomy in an Afro-Caribbean population in Guadeloupe (French West Indies)[J]. Prog Urol, 2018, 28(8- 9): 442-449. https://www.sciencedirect.com/science/article/pii/S1166708718300952 [9] 王琦, 潘正盛, 许传兵, 等.腹腔镜前列腺癌根治术后切缘阳性的影响因素对比分析[J].临床泌尿外科杂志, 2017, 32(7):538-540. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcmnwkzz201707011 [10] Karavitakis M, Ahmed HU, Abel PD, et al. Margin status after laparoscopic radical prostatectomy and the index lesion: implications for preoperative evaluation of tumor focality in prostate cancer[J]. J Endourol, 2012, 26(5):503-508. http://cn.bing.com/academic/profile?id=e023f236e1e22caf75ab5a1d9b6363be&encoded=0&v=paper_preview&mkt=zh-cn [11] Lightfoot AJ, Su YK, Sehgal SS, et al. Positive surgical margin trends in patients with pathologic T3 prostate cancer treated with robotassisted radical prostatectomy[J]. J Endourol, 2015, 29(6):634-639. doi: 10.1089/end.2014.0242 [12] Preston MA, Breau RH, Lantz AG, et al. The association between nerve sparing and a positive surgical margin during radical prostatectomy[J]. Urol Oncol, 2015, 33(1):18e1-18e6. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=WK_MED201811210991 [13] Nguyen LN, Head L, Witiuk K, et al. The risks and benefits of cavernous neurovascular bundle sparing during radical prostatectomy: a systematic review and Meta-analysis[J]. J Urol, 2017, 198(4):760- 769. doi: 10.1016/j.juro.2017.02.3344 [14] Du Y, Long Q, Guan B, et al. Robot-assisted radical prostatectomy is more beneficial for prostate cancer patients: a system review and Meta-analysis[J]. Med Sci Monit, 2018, 24:272-287. http://cn.bing.com/academic/profile?id=a221c7868f6c8157f3af3cd18843a9dc&encoded=0&v=paper_preview&mkt=zh-cn [15] Herforth C, Stroup SP, Chen Z, et al. Radical prostatectomy and the effect of close surgical margins: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database[J]. BJU Int, 2018, 122(4):592-598. doi: 10.1111/bju.2018.122.issue-4 -
点击查看大图
表(2)
计量
- 文章访问数: 114
- HTML全文浏览量: 28
- PDF下载量: 2
- 被引次数: 0
下载:
