根治性前列腺切除术后生化复发的危险因素分析

目的探讨根治性前列腺切除术后生化复发的危险因素。方法回顾性分析2010年1月至2020年12月空军军医大学第一附属医院收治的558例根治性前列腺切除术患者的临床资料。年龄平均67.9(40～87)岁, 体质指数平均24.56(15.12～35.94) kg/m2。前列腺特异性抗原(PSA)平均41.07 ng/ml, 其中<10ng/ml 48例, 10～20ng/ml 98例, >20 ng/ml 412例。术前穿刺病理Gleason评分6～10分者分别为123、214、118、89、14例。临床分期≤T2b期90例, T2c期273例, ≥T3期195例。558例均行根治性前列腺切除术, 其中528例行机器人辅助腹腔镜手术, 25例行腹腔镜手术, 5例行开放手术。采用Cox回归分析术后生化复发的危险因素。结果本组558例术后病理分期pT2a期63例, pT2b期32例, pT2c期241例, ≥pT3期222例。术后共210例出现生化复发, 生化复发时间平均33.3(3～127)个月。1、3、5年生化复发率分别为9.67%(54/558)、21.50%(120/558)...

Risk factor analysis of patients with biochemical recurrence after radical prostatectomy

Objective To investigate the risk factors for biochemical recurrence after radical prostatectomy.Methods The clinical data of 558 radical prostatectomy patients admitted to the First Affiliated Hospital of Air Force Military Medical University from January 2010 to December 2020 were retrospectively analyzed.The average age was 67.9(40-87)years old,and the average body mass index was 24.56(15.12-35.94)kg/m².The average PSA was 41.07 ng/ml,including 48 cases<10 ng/ml,98 cases 10-20 ng/ml,and 412 cases>20 ng/ml.There were 123,214,118,89,and 14 cases with biopsy Gleason 6-10 score,respectively.The clinical stage:90 cases in≤T2b,273 cases in T_2c,and 195 cases in≥T₃.558 cases underwent radical prostatectomy,including 528 robotic-assisted laparoscopic surgery,25 laparoscopic surgery,and 5 open-surgery.The risk factors for postoperative biochemical recurrence were analyzed by Cox regression.Results A total of 63 patients had postoperative pathological stage pT2a,32 patients had pT2b,241 patients had pT_2c,and 222 patients had≥pT₃.A total of 210 cases developed biochemical recurrence after surgery,and the mean time to biochemical recurrence was 33.3(3-127)months after the radical prostatectomy.The biochemical recurrence rates at 1,3,and 5 years were 9.7%(54/558),21.5%(120/558),and 31.7%(177/558),respectively.Among pT2a and pT2b patients,7(11.1%)and 4(12.5%)cases developed biochemical recurrence,respectively.Among pT_2cstage patients,145(60.17%)cases had positive cut margins,treated with androgen-deprivation therapy(ADT)after surgery.68(28.21%)cases of pT_2cstage patients had biochemical recurrence at mean 36.1(3-106)months after the radical prostatectomy.Among≥pT₃patients,147 patients with positive margins,perineural invasion,seminal vesicle invasion and positive pelvic lymph nodes were treated with postoperative androgen deprivation therapy(ADT)+radiotherapy.98 of 147 patients(66.67%)had biochemical recurrence,and the average time to biochemical recurrence was 30.6(24-98)months.75 patients of≥pT₃without positive margins,perineural invasion,seminal vesicle invasion or positive pelvic lymph nodes,were treated with postoperative ADT.33 of them(44%)had biochemical recurrence,and the average time to biochemical recurrence was 32.5(21-106)months.5-and 10-year survival rates of 210 patients with biochemical recurrence were 89.05%(187/210)and 78.09%(164/210)respectively,5-and 10-year tumor-specific survival rates were 92.57%and 87.69%,respectively.46 of 210 cases died,of which 31(67.39%)died from prostate cancer,and 15 cases(32.61%)died from cardiovascular and cerebrovascular diseases.Multifactorial Cox regression analysis showed that patient's age≥70 years,initial PSA>20ng/ml,≥pT₃and Gleason score≥7 were independent risk factors for biochemical recurrence.Conclusions After radical prostatectomy,patients were treated according to their pathological stage and surgical margins.Patients with positive margins have a higher risk of biochemical recurrence.The independent risk factors for biochemical recurrence included age≥70 years,initial PSA>20ng/ml,≥pT₃and Gleason score≥7.