Treatment of the positive surgical margin following radical prostatectomy

Objective With increased incidence of prostate cancer and an increased number of patients undergoing radical prostatectomy in China, it will be necessary to elaborate the diagnosis, clinical significance and treatment of patients whose tumors have positive surgical margins following radical prostatectomy.
Data sources Positive surgical margin, prostate cancer and radical prostatectomy were used as subject words and the medical literature in recent decades was searched using the PubMed database and the results are summarized.
Study selection Using positive surgical margin, prostate cancer and radical prostatectomy as subject words the PubMed medical database produced 275 papers of pertinent literature. By further screening 28 papers were selected and they represent relatively large-scale clinical randomized and controlled clinical trials.
Results A pertinent literature of 275 papers was identified and 28 papers on large clinical studies were obtained. Analysis of results indicated that the positive rate of surgical margin after radical prostatectomy is 20%-40%, and although most patients with positive surgical margins are stable for a considerable period, the data available now suggested that the presence of a positive surgical margin will have an impact on the patient＇s prognosis. The risk factors of positive surgical margin include preoperative prostate specific antigen level, Gleason＇s score and pelvic lymph node metastasis. The most common site with positive surgical margin is in apical areas of the prostate; therefore surgical technique is also a factor resulting in positive surgical margins. From data available now it appears that as long as the surgical technique is skilled, different surgical modes do not affect the rate of surgical margin. Adjuvant radiotherapy is mainly used to treat patients with positive surgical margin after radical prostatectomy, but combination with androgen deprivation therapy may increase the curative effect.
Conclusion The current data indicated that the presence of posit     

Prognostic value of Her-2/neu and clinicopathologic factors for evaluating progression and disease-specific death in Chinese men with prostate cancer

Background  Her-2/neu gene overexpression has been found in several malignancies, and is associated with poor prognosis; while its role in the tumorigenesis and progression of prostate cancer (PCa) is still controversial. This study aimed to evaluate the prognostic value of Her-2/neu protein expression and clinicopathologic factors in antiandrogen-treated Chinese men with PCa for disease progression and PCa-specific death.

Methods  Her-2/neu protein expression was determined using immunohistochemistry (IHC) in specimens collected from 124 prostate biopsies and transurethral resection of prostate (TURP) from seven prostate cancer patients.

Results  Her-2/neu protein expression was 0, 1+, 2+, and 3+ in 40 (30.5%), 8 (6.1%), 67 (51.1%), and 16 (12.2%) cases, respectively. Her-2/neu protein expression showed significant correlation as judged by Gleason score (P=0.049), clinical tumor-node-metastases (cTNM) stage (P=0.018) and disease progression (P=0.001), but did not correlate with prostate-specific antigen (PSA) (P=0.126) or PCa-specific death (P=0.585). PSA (P=0.001), Gleason score (P=0.017), cTNM (P=0.000) and Her-2/neu protein expression (P=0.001) had prognostic value for evaluating the progression of PCa in univariate analysis. In Kaplan-Meier plots, both Gleason score (P=0.035) and cTNM (P=0.013) correlated with PCa-specific death. In multivariate analysis, only cTNM was significant for both disease progression (P=0.001) and PCa-specific death (P=0.031).

Conclusions  Her-2/neu protein expression is significantly correlated with Gleason score, cTNM and disease progression, although it is not an independent predictor of disease progression and PCa-specific death. cTNM staging serves as an independent prognostic factor for disease progression and PCa-specific death.

     

Role of co-expression of c-Myc, EZH2 and p27 in prognosis of prostate cancer patients after surgery

Background  c-Myc, EZH2 and p27 were defined to modulate the behavior of prostate cancer with pro-tumoral or anti-tumoral effects and had ability in predicting prostate cancer progression, but the research of their co-expression value of prognosis is rarely. This study aimed to investigate the prognostic value of combining tri-marker together in patients with intermediate-risk prostate cancer after surgery.

Methods  Expression levels of c-Myc, EZH2 and p27 in 129 patients with intermediate-risk prostate cancer were assessed using immunohistochemistry in a semi-quantitative manner. The expression profiles of these three markers were analyzed and investigated for association with biochemical recurrence.

Results  In all, fifty of 129 cases experienced biochemical recurrence during a median follow-up time of 31 months (range, 6–60 months). Of these relapse patients, one case without and 10 cases with any single positive marker were observed; 39 cases were detected with any two or all three positive markers (22 cases with any two and 17 cases with all three positive markers). Survival analysis showed that patients with over-expression of c-Myc or EZH2, and lower expression of p27 manifested significantly higher biochemical recurrence rates. Subsequent multivariate analysis revealed that c-Myc, EZH2 and p27 expression statuses showed potential in predicting relapse, respectively. Notably, combining three markers together as a ‘‘composite index’’ (0 or 1, vs. 2 or 3 positive markers) provided powerful prognostic value (HR 6.57, 95% CI 3.02–14.31, P <0.001). There was a significant difference between the patient subgroups with 0 or 1 and those with 2 or 3 positive markers expression statuses, and tri-marker composite index was an independent risk factor for predicting relapse in patients with intermediate-risk prostate cancer after surgery.

Conclusion  Composite index of c-Myc, EZH2, and p27 can be valued as powerful prognosis parameter for intermediate-risk prostate cancer patients after the surgery, and postoperative adjuvant therapy can be adopted accordingly.

     

Arthroscopic treatment for osteochondral lesions of the talus: analysis of outcome predictors

Background  Compared with traditional arthrotomy procedures, arthroscopic treatment for osteochondral lesions of the talus has some advantages. However, there has been considerable debate about the outcome predictors for this surgical technique. This study aimed to investigate the outcomes of arthroscopic treatment for osteochondral lesions of the talus, and analyze its outcome predictors.
Methods  Clinical data of 48 patients with osteochondral lesions of the talus who underwent ankle arthroscopy were studied. Arthroscopic debridement was performed on all patients, and microfracture was also performed in 36 cases. Scores on a subjective satisfaction questionnaire, visual analog scale (VAS) for pain, and the American Orthopedic Foot & Ankle Society (AOFAS) ankle and hindfoot scores were obtained before and after surgery.
Results  Five patients lost to follow up. The other forty-three patients, 8 of whom were athletes, were followed up for an average of 23.9 months. The average AOFAS post-operative score was 90.16±9.96, compared with 70.81±6.96 before surgery (t=9.353, P <0.001). The VAS pain score after the operation (2.51±2.45) was significantly lower than that before the operation (6.95±1.40) (t=8.647, P <0.001). Of the 43 patients, 35 (81.4%) had good or excellent results. There was no significant difference in outcome between the medial and lateral groups (z=0.205, P=0.838), while a better outcome was found with lesions smaller than 10 mm than those with larger lesions (z=2.199, P=0.028). Age, sex, athletic profession and location of the lesion did not significantly correlate with outcomes.
Conclusions  Arthroscopic treatment is effective and safe for osteochondral lesions of the talus. A strong correlation was found between the size of the lesion and successful outcome.

     

Role of tumor necrosis factor-alpha in the pathogenesis of atrial fibrillation

Background  Tumor necrosis factor-alpha (TNF-α) is a pleiotropic proinflammatory cytokine and contributes to many kinds of cardiovascular diseases via its receptors (TNFR1/TNFR2). We hypothesize that TNF-α plays a role in the pathogenesis of chronic atrial fibrillation (AF).

Methods  Sixty-seven consecutive patients who were scheduled to have cardiac surgery were enrolled into the study. Thirty-one patients with rheumatic heart disease (RHD) and AF were enrolled as study group (AF group). The sinus rhythm (SR) control groups consisted of 20 patients with RHD and 16 patients with coronary artery disease (CAD). Peripheral blood sample was collected before the operation. About 5 mm3 left atrial tissue was disserted during the operation and was separated into three parts for Western blotting, real time polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC) analysis.

Results  Compared with the controls (RHD SR and CAD SR), the levels of TNF-α ((14.40±5.45) pg/ml vs. (4.20±3.19) pg/ml vs. (2.68±2.20) pg/ml, P=0.000) and its soluble receptor 1 (sTNFR1) ((1623.9±558.6) pg/ml vs. (1222.3±175.6) pg/ml vs. (1387.5±362.2) pg/ml, P=0.001) in plasma were higher in patients with AF. TNF-α level had positive correlation with the left atrial diameter (LAD) (r=0.642, P=0.000). Western blotting analysis showed that the protein levels of TNF-α (0.618±0.236 vs. 0.234±0.178 vs. 0.180±0.103, P=0.000) were higher in patients with AF. The RT-PCR analysis results demonstrated that the mRNA expression of TNF-α (0.103±0.047 vs. 0.031±0.027 vs. 0.023±0.018, P=0.000) increased in patients with AF. IHC analysis displayed that, comparing to the SR, the expression of TNF-α (0.125±0.025 vs. 0.080±0.027 vs. 0.070±0.023, P=0.000) increased in the AF group. The protein level and mRNA expression of TNF-α also had positive correlation with left atrium diameter (LAD) (r=0.415, P=0.000 and r=0.499, P=0.000).

Conclusions  The results revealed that TNF-α elevated in the plasma and left atrial tissue and had positive correlation with LAD in patients of chronic AF. TNF-α might involve in the pathogenesis of chronic AF.

     

Nerve plane-sparing radical hysterectomy: a simplified technique of nerve-sparing radical hysterectomy for invasive cervical cancer

Background  In order to simplify the complicated procedure of nerve-sparing radical hysterectomy, a novel technique characterized by integral preservation of the autonomic nerve plane has been employed for invasive cervical cancer. The objective of this study was to introduce the nerve plane-sparing radical hysterectomy technique and compare its efficacy and safety with that of nerve-sparing radical hysterectomy.

Methods  From September 2006 to August 2010, 73 consecutive patients with International Federation of Gynecology and Obstetrics stage IB to IIA cervical cancer underwent radical hysterectomy with two different nerve-sparing approaches. Nerve-sparing radical hysterectomy was performed for the first 16 patients (nerve-sparing radical hysterectomy group). The detailed autonomic nerve structures were identified and separated by meticulous dissection during this procedure. After January 2008, the nerve plane-sparing radical hysterectomy procedure was developed and performed for the next 57 patients (nerve plane-sparing radical hysterectomy group). During this modified procedure, the nerve plane (meso-ureter and its extension) containing most of the autonomic nerve structures was integrally preserved. The patients’ clinicopathologic characteristics, surgical parameters, and outcomes of postoperative bladder function were compared between the two groups.

Results  There were no significant differences between the nerve plane-sparing radical hysterectomy and nerve-sparing radical hysterectomy groups regarding age, International Federation of Gynecology and Obstetrics stage, pathological type, preoperative treatment, or need for intraoperative blood transfusion. The nerve plane-sparing radical hysterectomy group had a higher body mass index than that of the nerve-sparing radical hysterectomy group (P=0.028). The mean surgical duration in the nerve plane-sparing radical hysterectomy and nerve-sparing radical hysterectomy groups were (262±46) minutes and (341±36) minutes (P <0.01). On the 8th postoperative day, 41 (71.9%) patients in the nerve plane-sparing radical hysterectomy group and nine (56.3%) patients in the nerve-sparing radical hysterectomy group had a postvoid residual urine volume of <100 ml (P=0.233). The median duration of catheterization was eight days (range 8−23 days) for the nerve plane-sparing radical hysterectomy group and eight days (range 8−22 days) for the nerve-sparing radical hysterectomy group (P=0.509). Neither surgery-related injury nor pathologically positive margins were reported in either group.

Conclusion  Nerve plane-sparing radical hysterectomy is a reproducible and simplified modification of nerve-sparing radical hysterectomy, and may be preferable to nerve-sparing radical hysterectomy for treatment of early-stage invasive cervical cancer.

     

Effects of music therapy on depression and duration of hospital stay of breast cancer patients after radical mastectomy

Background  Breast cancer remains the most important cancer among women worldwide. The disease itself and treatment may have a profound impact on the patients’ psychological well being and quality of life. Depression is common in breast cancer patients and affects the therapeutic effects as well as prolongs the duration of hospital stay. However, few studies reported the effectiveness of music therapy on depression and duration of hospital stay of female patients with breast cancer after radical mastectomy.

Methods  One hundred and twenty subjects were recruited to this clinical trial and randomly allocated to two groups. The experimental group (n=60) received music therapy on the basis of routine nursing care, whereas the control group (n=60) only received the routine nursing care. The whole intervention time was from the first day after radical mastectomy to the third time of admission to hospital for chemotherapy. Data of demographic characteristics and depression were collected by using the General Questionnaire and Chinese version of Zung Self-rating Depression Scale (ZSDS) respectively. One pre-test (the day before radical mastectomy) and three post-tests (the day before discharge from hospital, the second and third admission to hospital for chemotherapy) were utilized. Duration of hospital stay was calculated from the first day after radical mastectomy to the day of discharged from hospital.

Results  The mean depression score of all subjects was 37.19±6.30. Thirty-six cases (30%) suffered from depression symptoms, with 26 (72.2%) mild depression cases, 9 (25.0%) moderate depression cases, and 1 (2.8%) severe depression case. After music therapy, depression scores of the experimental group were lower than that of the control group in the three post-tests, with significant differences (F=39.13, P <0.001; F=82.09, P <0.001). Duration of hospital stay after radical mastectomy of the experimental group ((13.62±2.04) days) was shorter than that of the control group ((15.53±2.75) days) with significant difference (t=–4.34, P <0.001).

Conclusions  Music therapy has positive effects on improving depression of female patients with breast cancer, and duration of hospital stay after radical mastectomy can be reduced. It is worthy of applying music therapy as an alternative way of nursing intervention in clinical nursing process of caring female patients with breast cancer.

     

法呢基转移酶在原发性肝癌中的表达

Background  Primary liver cancer (PLC) is a common malignant tumor. Over the past decade, although farnesyltransferase (FTase) has emerged as a significant target for anticancer therapies and has become a hotspot of cancer research, its exact mechanism of action remains unknown. The aim of this study was to investigate the expression of FTase in PLC and its role in the development of PLC.

Methods  Expression of FTase was detected by real-time fluorescent quantitative-polymerase chain reaction (FQ-PCR) in cancer and surrounding normal tissues from 32 patients with PLC.

Results  Expression of FTase mRNA in PLC was significantly higher than that in normal hepatic tissues (P <0.001). Overexpression of FTase was as high as 87.5%. The positive rate for FTase mRNA in the high tendency to metastatic recurrence group was obviously higher than that in the low tendency to metastatic recurrence group (P=0.02). The positive rate for FTase mRNA in patients with metastatic recurrence during postoperative follow-up was also significantly higher than that in those without metastatic recurrence (P=0.01).

Conclusions  The level of FTase mRNA expression in cancer tissues is much higher than in normal tissues. FTase may play an important role in the genesis and development of PLC and may be one of the reliable markers for the metastatic activity gained by liver tumor cells. FTase could be used clinically in predicting metastatic recurrence of PLC.     

Outcome of surgery for sinus of Valsalva aneurysm with discrete membranous subaortic stenosis

Background  Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly, and SVA with discrete membranous subaortic stenosis is even rarer. The aim of the study was to make sure the incidence of SVA with discrete membraneous subaortic stenosis in SVA and their surgical results. We retrospectively analyzed 234 patients receiving surgical repair of SVA and reported the incidence of ventricular septal defect, aortic regurgitation, and discrete membranous subaortic stenosis. We also reported seven cases of SVA combined with discrete membranous subaortic stenosis and their surgical results.

Methods  Between January 1999 and December 2009, seven patients of SVA with discrete membranous subaortic stenosis underwent surgical repair of SVA and resection of subaortic discrete membrane. There were six male and one female patients. The mean age was (33.71±13.25) years (range 16–52 years). Associated cardiovascular lesions were aortic regurgitation (n=7), ventricular septal defect (n=5), coarctation of aorta (n=1), bicuspid aortic valve (n=1), patent ductus arteriosus (n=1), and aortic valve stenosis (n=1). The aortic valve was replaced in four patients and valvuloplasty was done in three. The other co-existing anomalies were corrected at the same time. All the seven patients were followed up from 18 to 125 months (mean (63.14±39.54) months). Among 234 SVA patients who underwent surgical repair, the number of cases with coexisting ventricular septal defect, aortic regurgitation, and discrete membranous subaortic stenosis was 129, 108, and 7, respectively.

Results  There was neither early death after operation nor late death during the follow-up period. All the seven patients were in the New York Heart Association (NYHA) functional classes I and II. There was no recurrence of discrete subaortic membrane during the follow-up period. The incidence of ventricular septal defect, aortic valve incompetence, and discrete membranous subaortic stenosis among 234 SVA patients was 55.13%, 46.15%, and 2.99%, respectively.

Conclusions  Surgical repair of SVA with discrete membranous subaortic stenosis showed good mid-term results. Resection of discrete subaortic membrane should be done actively while repairing SVAs. Long-term results need to be followed up.

     

Toll-like receptor 9 is correlated to disease activity in Chinese systemic lupus erythematosus population

Background  Toll like receptor (TLR) 9 has been shown to play a crucial role in the pathogenesis of systemic lupus erythematosus (SLE) in animal models. Its pathogenic role in human SLE, however, was poorly elucidated. This study was performed to investigate the role of TLR9 involved in the aberrant signaling pathway and its correlation with disease activity in SLE.

Methods  mRNA level of TLR9 and interferon (IFN) regulatory factor 5 (IRF5) in peripheral blood mononuclear cells (PBMCs) were determined by real-time polymerase chain reaction (PCR). IFN-a expression was measured in the serum of the SLE patients by enzyme-linked immunosorbent assay (ELISA).

Results  TLR9 expression was significantly higher in SLE patients than that in health controls (P=0.011). SLE patients with positive anti-dsDNA antibody had significantly higher expression of TLR9 than that with negative anti-dsDNA antibody (P=0.001). TLR9 expression was positively correlated with fever (P=0.017), alopecia (P=0.046), safety of estrogens in lupus erythematosus national assessment SLE disease activity index (SELENA-SLEDAI) score (r_s=0.385, P=0.003), and the level of IRF5 (r_s=0.35, P=0.027) and IFN-a (r_s=0.627, P=0.001) in SLE patients.

Conclusion  TLR9 is associated with SLE disease activity and might be involved in the IFN-a pathway of SLE.

     

80岁及以上前列腺癌患者行腹腔镜前列腺根治性切除术围手术期参数及预后

目的：分析北京大学第三医院泌尿外科收治的超高龄（≥80岁）前列腺癌患者的围手术期参数、术后控尿功能恢复及肿瘤学预后,探讨中国人群超高龄前列腺癌患者接受腹腔镜前列腺根治性切除术治疗的安全性和有效性。方法：选择2007年1月至2016年12月于北京大学第三医院因前列腺腺癌行腹腔镜前列腺根治性切除术的超高龄（≥80岁）患者进行回顾性分析,纳入标准为患者年龄≥80岁,经组织病理学检查确诊为前列腺腺癌,临床资料齐备。所有患者均经腹膜外途径行腹腔镜前列腺根治性切除术,收集患者临床资料、围手术期参数、术后病理资料等。术后3个月、6个月和1年对患者控尿功能恢复情况进行随访,定期检测血清前列腺特异性抗原（prostate specific antigen, PSA）水平,将生化复发定义为连续两次血清PSA水平大于0.2 μg/L者,应用Kaplan-Meier生存曲线分析患者无生化复发生存率和总生存率,多因素COX回归分析影响超高龄前列腺癌患者术后生化复发的危险因素。结果：所有51例患者年龄（81.6±1.6）岁,穿刺前PSA (15.19±13.68) μg/L,穿刺Gleason评分为6分、7分和≥8分者分别为14例（27.5%）、19例（37.3%）和18例（35.3%）,临床分期为T1、T2和T3期者分别为6例（11.8%）、31例（60.8%）和14例（27.5%）,ASA分级Ⅰ级者6例,Ⅱ级者45例。所有患者均完成手术,手术时间（189.6±69.1） min,手术出血量（169.9±163.5） mL,11例（21.6%）患者发生围手术期并发症。通过超高龄前列腺癌患者腹腔镜前列腺根治性切除术(laparoscopic radical prostatectomy,LRP)术后的大体标本病理进行分析,术后病理分期T2期者29例（56.9%）,T3期22例者（43.1%）,其中包膜侵犯者18例（35.3%）,精囊侵犯者4例（7.8%）;大体病理Gleason评分6分、7分和≥8分者分别为8例（15.7%）、21例（41.1%）和22例（43.1%）,术后病理切缘阳性者14例（27.5%）。截止2017年10月术后随访10~118个月,中位随访时间42个月,术后3个月、6个月和1年超高龄前列腺癌患者行LRP术后的尿控率分别为64.7%(33/51)、82.4%(42/51)和 92.2%(47/51)。在随访过程中,12例（23.5%）超高龄前列腺癌患者LRP术后出现生化复发,平均生化复发时间为40.9个月;4例（7.8%）患者在随访过程中死亡,其中1例（2.0%）患者因前列腺癌进展死亡,3例（5.9%）患者因其他疾病死亡。经多因素COX回归分析,影响超高龄前列腺癌患者术后生化复发的危险因素主要为高PSA水平（P=0.019）、病理分期≥T3期（P =0.017）和切缘阳性（P =0.020）。结论：对选择恰当的超高龄前列腺癌患者施行腹腔镜前列腺根治性切除术是可行的,并且远期肿瘤控制情况良好,高PSA水平、病理分期≥T3期和切缘阳性可能是超高龄前列腺癌患者术后生化复发的独立危险因素,但此结论尚需大样本量的前瞻性临床研究证实。     

前列腺癌根治术后病理分期、Gleason评分与术前血清PSA的相关性分析

目的探讨前列腺癌患者根治术后病理分期、Gleason评分与术前血清PSA的相关性。方法收集香港中文大学附属威尔斯亲王医院泌尿外科2008年1月至2010年9月采用4-臂daVinci S-HD机器人外科手术系统施行前列腺根治性切除术的100例前列腺癌患者的临床资料数据,采用Spearman等级相关分析探讨根治术后病理分期、Gleason评分与术前血清PSA的相关性。结果患者PSA值与Gleason评分呈正相关(r=0.382,P<0.01),PSA值越高,Gleason评分值越高。PSA值与病理分期无明确的相关性(r=-0.073,P>0.05)。结论前列腺癌患者术前血清PSA与根治术后Gleason评分有关,与病理分期无明确的相关性。     

前列腺癌根治术中避免手术切缘阳性的临床评价

目的 探讨前列腺癌根治术中手术切缘阳性的临床意义,以及相关临床参数对手术切缘阳性率的影响.方法 63例经病理证实的局限性前列腺癌实施前列腺根治术,通过回顾性研究了解病理分期、术前血清PSA、穿刺后Gleason评分、穿刺针数阳性百分率对手术切缘阳性的影响.结果 63例前列腺癌病理分期T2a 19例,切缘阳性1例;T2b ll例,切缘阳性4例;T3a12例,切缘阳性0例;T3b 8例,切缘阳性4例;,r3c 10例,切缘阳性5例.病理分期与手术切缘阳性成正相关(r=7.166,P=0.007),且对手术切缘阳性有意义(χ2=15.326,P=0.004).本组偶发癌3例,切缘阳性1例.血清PSA异常63例,其中血清PSA＜10ng/ml 24例,术后切缘阳性4例,血清PSA＞10ng/ml 39例,术后切缘阳性12例,两者差异无显著性(χ2=2.236,P=0.135).穿刺后Gleason评分60例,其中＜7分40例,切缘阳性8例,＞7分20例,切缘阳性7例,两者差异无显著性(χ2=1.600,P=0.206).穿刺针数阳性百分率60例,其中＜33%例,切缘阳性3例,＞335例,切缘阳性12例,两者差异有显著性(χ2=3.863,P=0.049).结论 血清PSA、穿刺后Gleason评分对前列腺癌根治术中切缘阳性无影响,而穿刺阳性百分率对手术切缘阳性有意义,同时手术者经验和手术技能对手术切缘阳性有一定影响.     

机器人辅助与开放前列腺癌根治术切缘阳性情况比较

目的 比较单术者应用机器人辅助与开放前列腺癌根治术两种手术方式进行前列腺癌切除时肿瘤切缘阳性情况.方法 2009年1月至2017年5月期间,我院单术者分别应用开放前列腺癌根治术治疗的81例前列腺癌患者及机器人辅助前列腺癌根治术治疗的306例前列腺癌患者入组本研究.术后病理切缘阳性定义为前列腺癌根治标本切缘墨染标记处可见肿瘤细胞.通过我科前列腺癌随访数据库提取所有患者的年龄、术前前列腺特异抗原(PSA)水平、术后病理Gleason评分、病理T分期、上下切缘阳性情况等资料,使用倾向评分匹配法对两种术式的数据进行配对以保证其一致性,比较两种术式切缘阳性情况的差异.采用多因素logistic回归分析明确切缘阳性的独立影响因素.结果 将两组患者的年龄、术前PSA水平、术后病理Gleason评分、病理T分期作为预测变量进行倾向评分匹配后成功配对81对病例,开放前列腺癌根治术组和机器人辅助前列腺癌根治术组上切缘阳性率分别为22.2％ (1S/81)、18.5％(15/81),下切缘阳性率分别为29.6％(24/81)、30.9％ (25/81),总切缘阳性率分别为38.3％(31/81)、38.3％(31/81),两组间差异均无统计学意义.多因素logistic回归分析术前PSA水平及病理T分期是切缘阳性的独立影响因素(P=0.011,P=0.000).结论 机器人辅助前列腺癌根治术能够提供不亚于开放手术的肿瘤切除的完整性.     

前列腺癌根治术后患者Gleason评分3+4和4+3不同临床特征的比较

目的:通过将前列腺癌根治术后Gleason评分3 4和4 3患者进行对比,评价不同主要Gleason级别患者的临床特征差异.方法:回顾分析2001～2006年于我院行耻骨后前列腺根治性切除术的前列腺腺癌患者,37例术后病理诊断为Gleason 7分,根据主要级别不同分为3 4、4 3两组.定期随访判断患者有无生化复发或远处转移.应用放射免疫法检测血清前列腺特异性抗原(PSA)浓度,Kaplan-Meier法描述两组患者无进展生存曲线,COX回归模型分析影响疾病进展的独立相关因素.结果:两组患者前列腺包膜外侵犯率无统计学差异(21.1% vs 33.3%,P=0.462);3 4组患者术后无进展生存时间长于4 3组(P=0.030);COX回归模型显示Gleason级别是影响预后的独立相关因素(P=0.033),4 3组有着更高的生化复发风险.结论:不同分级的Gleason 7分前列腺癌的生物学行为不尽相同,根治术后3 4分和4 3分患者的预后明显不同,将Gleason 7分患者依照主要级别继续分型在临床上具有一定的可行性.     

穿刺活检单针阳性的前列腺癌手术策略选择及经验总结

目的: 分析穿刺活检单针阳性的前列腺癌患者行前列腺癌根治性切除术后的临床病理特征,以协助选择手术策略。方法: 回顾性分析2010年1月至2018年12月北京大学第三医院泌尿外科收治的经直肠前列腺系统穿刺活检单针阳性并且接受前列腺癌根治术的患者共计53例,患者年龄(69.7±6.9)岁(54~81岁)。穿刺前前列腺特异抗原(prostate specific antigen,PSA)为(9.70±5.24) μg/L(1.69~25.69 μg/L),前列腺体积为(50.70±28.39) mL(12.41~171.92 mL),穿刺Gleason评分6分、7分和≥8分者分别为39例(73.6%)、11例(20.8%)和3例(5.7%),临床分期T1期、T2期和T3期者分别为6例(11.3%)、44例(83.0%)和3例(5.7%)。按年龄、术前PSA水平、穿刺Gleason评分、单针肿瘤占穿刺组织百分比和临床分期等因素进行分组,比较各组患者的临床病理特征差异。结果: 术后Gleason评分6分、7分和≥8分者分别为 20例(37.7%)、21例(39.6%)和10例(18.9%),另有2例(3.8%)为pT0;病理分期T0期、T2a期、T2b期、T2c期和T3期者分别为2例(3.8%)、9例(17.0%)、2例(3.8%)、29例(54.7%)和11例(20.8%);11例(20.8%)手术切缘阳性,10例前列腺包膜外侵犯(18.9%),1例(1.9%)精囊侵犯。术后肿瘤呈多灶状分布42例(79.2%),双侧分布37例(69.8%)。与术前穿刺Gleason评分比较,术后Gleason评分下降3例(5.7%), 不变28例(52.8%),升级20例(37.7%),其中有2例(3.8%)为pT0;与临床分期比较,术后病理分期下降2例(3.8%),不变10例(18.9%),升级41例(77.4%)。根据术后病理分为微灶癌组(n=8)和非微灶癌组(n=45), 经比较,两组单针肿瘤占穿刺组织百分比(≤5%)差异有统计学意义(P=0.014),而年龄、前列腺体积、术前前列腺特异抗原密度(prostate special antigen density,PSAD)和术前穿刺Gleason评分差异无统计学意义(P>0.05);通过穿刺活检判断癌灶位于尖部的方法,假阴性率41.4%(12/29),假阳性率 50.0%(12/24)。实际清扫淋巴结和保留性神经的病例,与根据术后病理再次判断方案选择时存在统计学差异(P<0.05)。结论: 单针肿瘤占穿刺组织百分比≤5%是前列腺微灶癌的预测因素。37.7%病例发生病理分级升级和77.4%病例发生病理分期升级,选择手术方案(如性神经保护、淋巴结清扫、尖部的处理等)时,需要综合分析肿瘤危险度分层、列线图预测因素、多参数磁共振成像以及术中情况等多因素。     

穿刺活检单针阳性的前列腺癌手术策略选择及经验总结

目的: 分析穿刺活检单针阳性的前列腺癌患者行前列腺癌根治性切除术后的临床病理特征,以协助选择手术策略。方法: 回顾性分析2010年1月至2018年12月北京大学第三医院泌尿外科收治的经直肠前列腺系统穿刺活检单针阳性并且接受前列腺癌根治术的患者共计53例,患者年龄(69.7±6.9)岁(54~81岁)。穿刺前前列腺特异抗原(prostate specific antigen,PSA)为(9.70±5.24) μg/L(1.69~25.69 μg/L),前列腺体积为(50.70±28.39) mL(12.41~171.92 mL),穿刺Gleason评分6分、7分和≥8分者分别为39例(73.6%)、11例(20.8%)和3例(5.7%),临床分期T1期、T2期和T3期者分别为6例(11.3%)、44例(83.0%)和3例(5.7%)。按年龄、术前PSA水平、穿刺Gleason评分、单针肿瘤占穿刺组织百分比和临床分期等因素进行分组,比较各组患者的临床病理特征差异。结果: 术后Gleason评分6分、7分和≥8分者分别为 20例(37.7%)、21例(39.6%)和10例(18.9%),另有2例(3.8%)为pT0;病理分期T0期、T2a期、T2b期、T2c期和T3期者分别为2例(3.8%)、9例(17.0%)、2例(3.8%)、29例(54.7%)和11例(20.8%);11例(20.8%)手术切缘阳性,10例前列腺包膜外侵犯(18.9%),1例(1.9%)精囊侵犯。术后肿瘤呈多灶状分布42例(79.2%),双侧分布37例(69.8%)。与术前穿刺Gleason评分比较,术后Gleason评分下降3例(5.7%), 不变28例(52.8%),升级20例(37.7%),其中有2例(3.8%)为pT0;与临床分期比较,术后病理分期下降2例(3.8%),不变10例(18.9%),升级41例(77.4%)。根据术后病理分为微灶癌组(n=8)和非微灶癌组(n=45), 经比较,两组单针肿瘤占穿刺组织百分比(≤5%)差异有统计学意义(P=0.014),而年龄、前列腺体积、术前前列腺特异抗原密度(prostate special antigen density,PSAD)和术前穿刺Gleason评分差异无统计学意义(P>0.05);通过穿刺活检判断癌灶位于尖部的方法,假阴性率41.4%(12/29),假阳性率 50.0%(12/24)。实际清扫淋巴结和保留性神经的病例,与根据术后病理再次判断方案选择时存在统计学差异(P<0.05)。结论: 单针肿瘤占穿刺组织百分比≤5%是前列腺微灶癌的预测因素。37.7%病例发生病理分级升级和77.4%病例发生病理分期升级,选择手术方案(如性神经保护、淋巴结清扫、尖部的处理等)时,需要综合分析肿瘤危险度分层、列线图预测因素、多参数磁共振成像以及术中情况等多因素。     

腹腔镜单纯尿道前壁加强法与尿道前后壁加强法(Sandwich法)改善前列腺癌根治术后早期尿控的对比分析

目的 探讨腹腔镜单纯尿道前壁悬吊加强法和尿道前后壁加强法对前列腺癌根治术后早期尿控的疗效。方法 纳入自2014年2月至2019年12月,首都医科大学附属北京朝阳医院泌尿外科收治的99例前列腺癌患者,其中56例采用尿道前后壁加强法治疗,43例采用单纯尿道前壁悬吊加强法治疗,比较两组患者的年龄、体质量指数、前列腺体积、术前前列腺特异性抗原（prostate specific antigen,PSA）,临床分期、手术时间、病理分期、Gleason评分、淋巴结阳性率、术后切缘阳性率及通过电话随访拔除尿管后第2、4、12、24、52周时的尿控恢复情况。结果 两组患者的年龄、体质量指数、前列腺体积、PSA、临床分期、手术时间、病理分期、Gleason评分、淋巴结阳性率、术后切缘阳性率差异均无统计学意义（P>0.05）,拔除尿管后第12周可见单纯尿道前壁悬吊加强法的治疗效果优于尿道前后壁加强法,但各指标差异仍无统计学意义（P=0.058）。结论 腹腔镜前列腺癌根治术中采用前壁加强缝合悬吊法安全易行,与前后壁双重加强的方法相比,疗效接近。     

不同途径经腹膜外腹腔镜下根治性前列腺切除术的临床疗效分析

目的探讨不同途径经腹膜外腹腔镜下根治性前列腺切除术（ELRP）治疗局限性前列腺癌的临床疗效。方法对87例经ELRP治疗的局限性前列腺癌病人临床资料进行回顾性分析,其中三孔法ELRP组28例,四孔法ELRP组59例。所有病人术前均行前列腺穿刺活检或前列腺电切术后病理证实为前列腺癌,且排除外周组织器官浸润及盆腔淋巴结转移。对2组病人年龄、总前列腺特异性抗原（tPSA）、前列腺体积、临床分期、高血压、手术时间、术中出血量、术后Gleason评分、手术切缘阳性、术后生化复发率和术后尿管留置时间等分析比较。结果所有病人均顺利完成手术,无一例中转开放手术。三孔法ELRP组手术时间、术中出血量、前列腺体积分别为（90.56±17.87）min、（121.45±45.76）mL、（36.75±12.26）mL,均少于四孔法ELRP组的（118.66±22.45）min、（189.87±75.43）mL、（67.47±22.65）mL（P < 0.05）;切缘阳性数分别为2例和4例、术后加用内分泌治疗,2组差异无统计学意义（P>0.05）。此外,2组病人在年龄、tPSA、临床分期、术前是否合并高血压、术后Gleason评分、术后尿管留置时间及术后复发方面差异均无统计学意义（P>0.05）。术后随访3~17月,生化复发6例,予内分泌治疗后控制满意。结论相比于四孔法ELRP,三孔法ELRP不仅尚未增加并发症,而且更加微创,对于体积较小局限性前列腺癌值得临床推广应用。     

3D腹腔镜与2D腹腔镜下腹膜外前列腺癌根治术双中心回顾性队列研究

  目的  分析比较2D腹腔镜下与3D腹腔镜下前列腺癌根治术治疗前列腺癌的有效性与安全性。  方法  回顾性分析南方医科大学南方医院泌尿外科及广东省人民医院2个中心泌尿外科2015年1月1日—2018年1月1日期间行腹腔镜前列腺癌根治术患者，共122例患者临床资料，根据所采用的腔镜方式不同，分为3D腹腔镜组(40例)和2D腹腔镜组(82例)；通过倾向性评分匹配法对2D腹腔镜前列腺癌根治组(2D腹腔镜组)和3D腹腔镜前列腺癌根治组(3D腹腔镜组)患者根据年龄、BMI、前列腺体积、术前总前列腺特异性抗原(PSA)、前列腺穿刺病理Gleason评分等进行匹配后2组各纳入40例。对匹配成功的患者采用尿失禁生活质量量表(I-QOL)、勃起功能国际问卷-5(IIEF-5)进一步随访，分析2种手术方式效果差异，对比分析2种手术方式安全性。  结果  3D腹腔镜组比2D腹腔镜组手术时间短[2.3(2.0, 3.0)h vs. 3.0(2.3, 4.0)h, P=0.023]，出血量更少[50.0(50.0, 137.5)mL vs. 275.0(112.5, 337.5) mL, P＜0.001]；但2组切缘阳性率、尿漏率、尿控恢复率、性功能恢复及无生化复发率比较差异无统计学意义(均P＞0.05)。  结论  3D腹腔镜下前列腺癌根治术可获得更好视野，减少手术时间、出血量。但2组远期随访切缘阳性率、尿控恢复率、性功能恢复及生化复发率等方面手术效果相近。