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

目的探讨经腹腔途径腹腔镜前列腺癌根治术后切缘阳性的相关影响因素。方法 2009年9月至2014年5月,采用经腹腔途径行腹腔镜下前列腺癌根治术61例。患者年龄56~74岁,平均71岁。术前均经直肠超声引导下穿刺病理证实前列腺癌诊断。通过回顾性研究了解术前血清前列腺特异性抗原(PSA)、穿刺后Gleason评分、穿刺针数阳性百分率,术前TNM分期对手术切缘阳性的影响。结果61例前列腺癌患者术后切缘阳性率19.7%(12/61),病理分期与手术切缘阳性成正相关(γ=0.311,P=0.001),且对手术切缘阳性有统计学意义(χ~2=16.32,P=0.001);对于手术切缘阳性率,术前血清PSA20ng/ml组与血清PSA≥20ng/ml组比较,差异有统计学意义(χ~2=7.32,P=0.007);穿刺后Gleason评分7分组与Gleason评分≥7分组差异无统计学意义了(χ~2=1.43,P=0.23);穿刺针数阳性百分率,50%组与≥50%组差异有统计学意义(χ~2=4.32,P=0.017)。结论穿刺后TNM分期,血清PSA水平,穿刺阳性百分率的差异对手术切缘阳性有统计学意义。前列腺癌穿刺标本Gleason评分与术后病理切缘之间无相关性。     

腹腔镜前列腺癌根治术后切缘阳性的影响因素对比分析

目的:对比分析腹腔镜前列腺癌根治术后切缘阳性的相关影响因素。方法:选取2012年9月~2015年9月于我院住院部就诊的经穿刺病理诊断为前列腺癌并行腹腔镜前列腺癌根治术的108例患者,回顾性分析术前血清PSA、穿刺后Gleason评分、病理T分期与术后切缘阳性的相关性。结果:不同术前血清PSA10ng/ml、10~20ng/ml与20ng/ml三组差异无统计学意义(χ~2=3.69,P=0.21);不同穿刺后Gleason评分,≤6、7与≥8三组差异无统计学意义(χ~2=7.8,P=0.063);而不同病理T分期,T_(1a)~T_(2a)、T_(2b)与T_(2c)~T_(3b)三组差异有统计学意义(χ~2=6.371,P=0.041)。同时通过对术前血清PSA、穿刺后Gleason评分、病理T_2及T_3分期这4个变量进行Logistic回归分析,得出结果无论是总体部位还是前列腺体部,病理T_3期都是影响术后切缘阳性的一个重要因素。结论:术前血清PSA值及穿刺后Gleason评分与前列腺癌术后切缘阳性无相关性,穿刺病理T分期对前列腺癌根治术后切缘阳性的差异有统计学意义,并且病理T_3期是影响术后切缘阳性的一个独立因素。     

腹腔镜根治性前列腺切除术后切缘阳性的相关因素分析

目的：分析腹腔镜根治性前列腺切除术后切缘阳性的相关因素。方法：2004年1月～2010年12月,我院完成腹腔镜根治性前列腺切除术188例,平均年龄72岁。患者根治术前均经病理检查确诊为前列腺癌,未发现肿瘤转移征象。采用单因素分析研究各参数对切缘情况的影响,采用多因素Logistic回归分析确定切缘阳性的独立危险因素。结果：除2例患者中转开放手术外,其余患者均在腹腔镜下完成手术。平均手术时间246min,平均出血量309ml。术后病理回报切缘阳性76例,占40．5％。单因素分析提示切缘阳性组与切缘阴性组穿刺Gleason评分、穿刺阳性针数、根治病理Gleason评分、病理分期差异有统计学意义（P〈0．05）。多因素Logistic回归分析显示根治标本Gleason评分、病理分期是切缘阳性的独立相关因素。根治标本Gleason评分8分相对于Gleason评分6分患者切缘阳性风险增高17．1倍（比值比为17．131,95％置信区间为5．237～56．037,P〈0．001）,病理分期T1期相对于T2期患者切缘阳性风险增高9．0倍（比值比为8．970,95％置信区间为4．128～19．493,P〈0．001）。结论：根治标本Gleason评分、病理分期是腹腔镜根治性前列腺切除术后切缘阳性独立危险因素。根治标本Gleason评分为8分、病理分期为T3期患者的切缘阳性率显著增高。     

腹腔镜前列腺癌根治术后切缘阳性的影响因素分析

目的 分析腹腔镜前列腺癌根治术后病理标本切缘阳性的影响因素。方法 收集2019-07—2021-07于郑州大学第一附属医院泌尿外科行前列腺癌根治术的92例患者的临床资料,根据术后病理结果分为切缘阳性组和切缘阴性组。比较2组患者的年龄、体质量指数(BMI)、新辅助治疗、初诊前列腺特异性抗原(PSA)、术前PSA、穿刺Gleason评分、临床T分期,MRI前列腺体积、上下径、左右径、前后径,手术时间、出血量;术后前列腺体积、上下径、左右径、前后径,术后Gleason评分和病理T分期。采用单因素和多因素Logistic回归分析分别对变量进行分析,寻找切缘阳性的影响因素。结果 本组92例患者平均年龄(67.22±7.25)岁,均顺利完成手术,无术中转开放手术。切缘阳性组31例(33.7%),切缘阴性组61例(66.3%)。所有患者术后病理结果均证实为前列腺癌。单因素分析结果显示,初诊PSA、术前PSA、临床T分期、术前Gleason评分、病理T分期,以及术后Gleason评分的差异均有统计学意义(P<0.05);年龄、BMI,前列腺体积、横径、垂直径、前后径,手术时间、出血量的差异无统计...     

前列腺体积对腹腔镜下前列腺根治性切除术后组织病理学预后的影响

目的 探讨术前前列腺体积对于腹腔镜下前列腺根治性切除术后组织病理学预后的影响. 方法 回顾性分析2006年10月至2011年3月216例经前列腺穿刺括检诊断为前列腺腺癌并行腹腔镜下前列腺根治性切除术患者的资料,根据术前经直肠前列腺超声检查测定的前列腺体积将患者分为较小前列腺组( ＜30 ml)103例(47.7％)、中等前列腺组(30 ～60 ml)71例(32.9％)和较大前列腺组( ＞60ml)42例(19.4％).术前资料包括患者确诊时年龄、体质指数(BMI)、PSA、前列腺体积、穿刺阳性百分数、临床分期、穿刺Gleason评分等,术后组织病理学参数包括患者大体病理Gleason评分、是否存在术后病理升级、病理分期、切缘情况等.比较3组患者临床资料和术后组织病理学参数并进行统计学分析. 结果 3组患者术前PSA值随前列腺体积增大而升高,组间差异有统计学意义(P＜0.01),年龄、BMI、穿刺Gleason评分、穿刺阳性百分数及临床分期等对比较差异均无统计学意义(P＞0.05).小体积前列腺与较差的组织病理学预后相关,小体积前列腺痛患者术后Gleason评分较高(P =0.034),更容易出现大体病理升级现象(P=0.037),术后病理分期晚(P=0.025),特别是包膜侵犯的发生率增高(P =0.013).前列腺体积由小至大3组标本切缘阳性率分别为35.0％、33.8％和19.0％,差异无统计学意义(P =0.152). 结论 前列腺体积较小的前列腺癌患者行腹腔镜下前列腺根治性切除术后的组织病理学预后较差,肿瘤恶性程度高、病理分期晚,在临床工作中应予以重视.     

前列腺癌分期方法的临床评价

目的 :探讨临床参数对前列腺癌分期的临床意义。　方法 :通过病理诊断、MRI检查及全身骨扫描对 112例经前列腺活检病理证实的前列腺癌进行分期 ,结合血清前列腺特异抗原 (PSA)、穿刺后Gleason评分、穿刺阳性针数百分率评价其临床意义。　结果 :112例前列腺癌中 ,血清PSA、Gleason评分、穿刺阳性针数百分率对前列腺癌分期有显著相关性 (r=0 .6 98,r=0 .6 74 ,r=0 .6 71,P均 <0 .0 0 1) ,但对B期和C期前列腺癌的诊断差异无显著性 (χ2=2 .6 75 ,P =0 .0 96 ;χ2 =0 .70 4 ,P =0 .4 0 1) ,血清PSA较Gleason评分和穿刺阳性针数百分率对D期的诊断差异有显著性 (χ2 =5 .135 ,P =0 .0 2 3;χ2 =4 .5 93,P =0 .0 32 )。血清PSA、Gleason评分和穿刺阳性针数百分率的敏感性分别为 76 .7%、83.3%和 77.8% ,特异性为 5 0 %、77.3%和 5 4 .5 % ,准确性为 71.4 %、82 .1%和 73.2 %。　结论 :血清PSA、Gleason评分、穿刺阳性针数百分率可预测前列腺癌的分期 ,穿刺后Gleason评分对前列腺癌分期的预测较血清PSA和穿刺阳性针数百分率更准确。血清PSA对远处转移性前列腺癌的预测更有意义     

腹腔镜下前列腺癌根治术后切缘阳性的相关因素分析

目的 探讨腹腔镜下前列腺癌根治术后切缘阳性的相关因素. 方法 2004年2月至2007年9月,采用腹膜外途径行腹腔镜下前列腺癌根治术33例.患者年龄57～78岁,平均70岁.术前均经病理证实前列腺癌诊断.Gleason评分3+3者14例(43%)、3+4者11例(33%)、4+3者6例(18%)、4+4者2例(6%),临床分期T1a～T1b 4例(12%)、T1c14例(43%)、T2a～T2b 5例(15%)、T2c 10例(30%).多因素回归分析比较根治术后标本切缘阳性与阴性组临床及生物学参数指标. 结果 腹腔镜下完成前列腺癌根治术31例,中转开放手术2例.术后病理报告切缘阳性9例(27%)、阴性24例(73%).切缘阳性组与阴性组患者术前临床分期T2c分别为6例(67%)和4例(17%)(P=0.010),术后Gleason评分＞7分者分别为3例(33%)和0例(P=0.015),术前PSA＞20ng/ml分别为4例(44%)和5例(21%)(P=0.178),直肠指诊可触及结节或局部质硬者分别为4例(44%)和9例(38%)(P=0.509).多因素回归分析结果显示:临床分期T2c与切缘阳性呈独立正相关关系(OR=24.69),T2c患者术后切缘阳性率明显增高.术前Gleason评分＞7分者切缘阳性率增高,PSA＞20 ng/ml者切缘阳性率有增高趋势,但二者需结合临床分期等指标综合判断对术后切缘阳性的影响.直肠指诊触及结节或质硬者切缘阳性率略增高,可作为参考指标. 结论 影响腹腔镜下前列腺癌根治术后切缘阳性的因素为临床分期、术前病理Gleason评分、总PSA和直肠指诊.临床分期可以作为预测术后切缘阳性的独立相关因素,≥T2c期的患者术后切缘阳性率明显增加.Gleason评分＞7分、PSA＞20 ng/ml作为重要参考指标,应结合临床分期综合分析;直肠指诊有结节或质硬可作为参考指标.     

腹腔镜和开放前列腺癌根治术后配对比较切缘阳性情况

目的 通过配对比较腹腔镜和开放性前列腺癌根治术两种不同手术方式,明确术后切缘阳性的影响因素。方法 回顾性分析我院2012年12月至2014年7月行前列腺癌根治术230例患者,其中行开放手术136例,腹腔镜94例,术后通过前列腺整体组织大切片的方式由我院泌尿病理医师阅片评估术后切缘阳性情况及部位。结果 通过倾向指数评分配对比较腹腔镜和开放手术效果,其中腹腔镜94例占40.9%。根据患者年龄、PSA水平和穿刺Gleason评分进行配对,最终选取腔镜和开放手术患者各94例进行分析。两组人群的年龄、PSA水平、穿刺Gleason评分和病理T分期均无显著差异。年龄、PSA、穿刺Gleason综合、T分期和手术方式5个变量进行多因素分析,可发现仅有术后病理T分期可作为切缘阳性的独立预后因素。无论是总体切缘阳性率还是不同部位的切缘阳性率,腹腔镜手术和开放手术相比均没有显著差异(P>0.05)。结论 两组人群的手术切缘阳性率没有显著性差异,提示腹腔镜手术提供了不劣于开放手术的肿瘤切除的完整性。     

局限性前列腺癌腹腔镜根治性切除术术前与术后病理特征的比较

目的比较不同分组局限性前列腺癌患者术前与腹腔镜前列腺根治性切除术后Gleason评分的变化,分析低危组Gleason评分升级的危险因素。方法回顾性分析了2009年1月至2019年1月我院局限性前列腺癌行腹腔镜前列腺根治性切除术患者的临床资料。收集患者的年龄、前列腺体积、前列腺特异性抗原(PSA)、组织活检针数、阳性针数、组织活检Gleason评分、cTNM、术后病理Gleason评分和pTNM,根据前列腺癌风险分级分组。结果本研究共纳入346例患者,低危组63例、中危组163例、高危组120例。术后出现Gleason评分升级的患者中低危组23例(35.93%)、中危组37例(22.70%)、高危组41例(34.17%)。低危组前列腺癌Gleason评分升级组与未升级组之间术前PSA水平、穿刺阳性率及前列腺体积差异具有统计学意义(P<0.05),多因素Logistic回归分析结果显示,低危组中前列腺体积小、术前PSA水平高是腹腔镜前列腺根治术后病理升级的独立危险因素(P<0.05)。结论术前穿刺病理与术后病理结果的Gleason评分相比术前穿刺病理的Gleason评分明显被低估;低危组中前列腺体积较小与术前PSA水平高的患者可能更适合手术治疗。     

前列腺癌患者术前分期分级偏低的相关危险因素

目的 探讨前列腺癌根治术患者术前分期分级偏低的相关危险因素。方法 对55例前列腺癌根治术患者手术前后分期分级的资料进行比较，分析术前临床分期低于术后病理分期的危险因素。结果 55例患者术前临床分期T1～T250例，其中21例术后病理分期为T3～T4，占42％。26例术前穿刺活检病理Gleason评分2-6分者中11例术后病理分级为7-10分，占42％。Logisatic回归分析筛选出血清PSA（P＝0．0159)及前列腺穿刺阳性针数的百分率(P＝0．0013)是预测术前临床分期低于术后病理分期的危险因素。结论 对于临床分期为T1～T2而血清PSA≥20ng／ml或前列腺穿刺阳性针数≥50％的患者应考虑到临床分期偏低的可能。     

前列腺癌切缘阳性风险列线图的建立和验证

目的:建立预测前列腺癌术后切缘阳性结果的列线图模型,并进行相应的验证,为预测术后切缘阳性的风险提供依据。方法:纳入PC-follow数据库中北京医院、北京大学第一医院、北京大学第三医院、海军军医大学第一附属医院、西安交通大学第一附属医院2015—2018年收治的2215例前列腺癌患者的病例资料,年龄67.3(33~88)岁。PSA(45.2±18.9)ng/ml。前列腺穿刺活检针数6~32针,穿刺阳性针数百分比4%~100%,穿刺活检病理Gleason评分6~10分。采用单纯随机抽样法将患者分为建模组和验证组。建模组1770例,年龄65.5(33~88)岁,PSA(48.2±12.4)(0.01~99.4)ng/ml。验证组445例,年龄68.6(47~82)岁,PSA(43.7±14.8)(0.01~87.2)ng/ml。对两组患者年龄(<60岁,60~70岁,>70岁)、PSA(<4 ng/ml,4~10 ng/ml,11~20 ng/ml,>20 ng/ml)、盆腔MRI检查结果(阴性,可疑,阳性)、肿瘤临床分期(T 1~T 2期,≥T 3期)、穿刺阳性针数百分比(≤33%,34%~66%,>66%)、穿刺活检病理Gleason评分(≤6分,7分,≥8分)进行单因素和多因素logistic分析,筛选有意义的指标构建预测前列腺癌术后切缘阳性结果的列线图模型。在验证组对该模型进行验证,并与构成列线图的单一因素的预测效果进行比较。结果:单因素分析结果显示,术前PSA水平、盆腔MRI检查结果、穿刺针数阳性率、穿刺病理Gleason评分与术后切缘阳性率有相关性(P<0.05)。多因素分析结果显示,术前PSA水平(OR=2.046,95%CI 1.022~4.251,P=0.009)、穿刺阳性针数百分比(OR=1.502,95%CI 1.136~1.978,P=0.002)、穿刺病理Gleason评分(OR=1.568,95%CI 1.063~2.313,P=0.028)、盆腔MRI检查结果(OR=1.525,95%CI 1.160~2.005,P=0.033)为前列腺癌术后切缘阳性的独立预测指标,根据上述指标建立列线图模型。列线图模型预测验证组切缘阳性的受试者工作特征曲线(ROC)的曲线下面积为0.776,而以术前PSA水平、穿刺阳性针数百分比、穿刺病理Gleason评分、盆腔MRI检查结果、术后病理Gleason评分等单一因素预测验证组切缘阳性的ROC曲线下面积分别为0.554、0.615、0.556、0.522和0.560,列线图模型与单一指标比较差异均有统计学意义(P<0.05)。结论:构建的列线图模型较单独应用术前PSA水平、穿刺阳性针数百分比、穿刺病理Gleason评分、盆腔MRI检查结果、术后病理Gleason评分在预测前列腺癌术后切缘阳性方面具有更高的诊断价值。     

The percent of cores positive for cancer in prostate needle biopsy specimens is strongly predictive of tumor stage and volume at radical prostatectomy

PURPOSE: Pretreatment clinical staging of prostatic adenocarcinoma is important due to the increasing use of nonsurgical treatment options. Using multivariate analysis we assessed the predictive value of biopsy cores positive for cancer as a percent of all cores obtained as well as the percent surface area of needle cores involved with tumor for determining tumor volume and pathological stage at radical prostatectomy. Candidate variables for the multivariate model included patient age, clinical disease stage, serum prostate specific antigen (PSA) and Gleason score of cancer in the needle biopsy. MATERIALS AND METHODS: We reviewed prostate needle biopsy findings in 207 consecutive patients who subsequently underwent radical retropubic prostatectomy. Each biopsy specimen was assessed for tumor involvement by calculating the percent of cores positive for cancer, percent surface area involved in all cores and Gleason score. Initial serum PSA and preoperative clinical disease stage were incorporated with biopsy results into a multivariate model to determine the parameters most predictive of pathological stage and tumor volume at radical retropubic prostatectomy. RESULTS: Of the 207 patients 152 (73.4%) had organ confined cancer and 55 (26.6%) had extraprostatic extension (pathological stages T2 and T3 or greater, respectively). Preoperative clinical staging information was available in 195 cases, in which disease was clinically confined and not confined in 184 (94.4%) and 11 (5.6%), respectively. Needle biopsy revealed a surface area of cancer ranging from less than 5% in 69 patients (33.3%) to 90% (mean 16, median 10). Univariate analysis demonstrated that the risk of extraprostatic extension was predicted by preoperative serum PSA (p = 0.027), the percent of cores and percent of surface area positive for cancer (p <0.0001), and Gleason score (p = 0.0009). Clinical stage approached significance (p = 0.071). Multivariate analysis showed that the percent of positive cores (p = 0.0003), initial serum PSA (p = 0.005) and Gleason score of cancer in the needle biopsy (p = 0.03) were the only parameters that jointly predicted pathological stage (T2 versus T3). Percent of tumor surface area involvement in the needle biopsies did not add any more information after the percent of positive cores was known. Univariate analysis revealed that the percent of cores positive for cancer (Spearman r = 0.52, p <0.0001), Gleason score (Spearman r = 0.34, p <0.0001) and initial serum PSA (Spearman r = 0.24, p = 0.003) were predictive of log tumor volume at radical prostatectomy, while clinical stage was not (rank sum test p = 0.14). On multivariate analysis the percent of positive cores (p <0.0001), Gleason score (p <0.0001) and initial serum PSA (0.0033) were the only variables that jointly were predictive of tumor volume. CONCLUSIONS: The percent of needle biopsy cores and surface area positive for cancer are the strongest predictors of pathological stage and tumor volume on multivariate analysis incorporating preoperative serum PSA and Gleason score.     

Gleason score 7 prostate cancer on needle biopsy: is the prognostic difference in Gleason scores 4 + 3 and 3 + 4 independent of the number of involved cores?

PURPOSE: We addressed whether Gleason score 3 + 4 = 7 and 4 + 3 = 7 cancers on needle biopsy behave differently and whether this behavior is independent of the number of cores involved by cancer. If it is not an independent predictor of prognosis, one may report Gleason score 7 cancer with the number of positive cores without regard to whether the primary pattern was 3 or 4. This practice would remove a source of poor interobserver reproducibility when grading prostate cancer on needle biopsy. MATERIALS AND METHODS: We identified 537 patients with Gleason score 7 tumors on biopsy. The results of patient preoperative digital rectal examination, serum prostate specific antigen (PSA) measurement and age were used to predict 4 outcomes based on assessment of the corresponding radical prostatectomy specimens, including 1) pathological stage (organ confined, focal extraprostatic extension, nonfocal extraprostatic extension or seminal vesicle-lymph node involvement), 2) organ confinement (yes/no), 3) Gleason score and 4) surgical margin status (positive/negative) RESULTS: Multivariate regression of postoperative Gleason score groups against all 5 input variables (3 + 4 versus 4 + 3, number of positive cores, PSA, age and digital rectal examination) yielded a statistically significant positive correlation with preoperative PSA (p <0.001) and preoperative Gleason scores of 4 + 3 versus 3 + 4 on biopsy (p <0.001). Pathological stage correlated with preoperative PSA (p <0.001), Gleason score 4 + 3 disease (p = 0.016), positive digital rectal examination (p <0.001) and 3 or more positive cores (p = 0.016). Positive surgical margins were predicted only by preoperative PSA (p = 0.001). CONCLUSIONS: Because the biological behavior of biopsy Gleason score 3 + 4 or 4 + 3 of Gleason score 7 cancer differs regardless of the number of cores involved, future nomograms predicting pathological stage would benefit from examining 3 + 4 and 4 + 3 disease separately.     

新辅助治疗的优势:机器人辅助腹腔镜下前列腺癌根治术治疗局部进展期前列腺癌

目的探讨术前新辅助内分泌治疗(NHT)是否能使接受机器人辅助腹腔镜前列腺癌根治术(RLRP)治疗的局部进展期前列腺癌患者临床获益。方法回顾性研究中国医科大学附属第一医院泌尿外科自2018年5月至2019年8月根治术前通过穿刺活检及MRI诊断为局部进展期前列腺癌患者31例。其中术前行新辅助内分泌治疗12例,年龄(65.67±5.123)岁,未经内分泌治疗19例,年龄(66.58±8.520)岁。比较两组患者手术时间、术中出血量、术后住院时间、术后切缘阳性率、淋巴结阳性率、术后吻合口漏尿等情况。结果 31例手术均无中转开放及二次手术。新辅助治疗组手术时间[(176.84±54.875)min vs.(66.58±8.520)min,P=0.032]和术后住院时间[(9.50±2.505)min vs.(13.87±5.987)min,P=0.048]缩短,术中失血量[(165.68±79.746)mL vs.(13.87±5.987)mL,P=0.013]减少。治疗组肿瘤切缘阳性率(8.33%vs.26.32%,P=0.001)和清扫淋巴结阳性率(17.14%vs.38.18%,P=0.037)也明显低于对照组。术前辅助内分泌治疗并不能降低术后Gleason评分和临床分期(P>0.05)。结论术前新辅助内分泌治疗在RLRP治疗局部进展期前列腺癌患者中可能在一定程度上降低手术难度并且减少术中出血,使患者受益。     

^68Ga-PSMA PET-CT检查中SUVmax与前列腺癌患者临床病理特点的相关性分析

目的探讨^68Ga-PSMA PET-CT检查中前列腺局部病灶最大标准摄取值(maximum standardized uptake value,SUVmax)与前列腺癌患者临床病理特点的相关性。方法回顾性分析2016年5月至2019年8月北京大学肿瘤医院行^68Ga-PSMA PET-CT检查并行根治性前列腺切除术患者的病例资料。共31例患者。年龄(63.1±4.9)岁。体质指数(24.6±3.0)kg/m^2。血清总PSA(72.71±173.15)ng/ml。14例有基线睾酮数值,基线睾酮(4.72±1.64)ng/ml。穿刺病理Gleason评分按国际泌尿病理学会(International Society of Urological Pathology,ISUP)分级:1级5例,2级7例,3级4例,4级10例,5级5例。术前临床分期:T2a期6例,T2b期2例,T2c期17例,T3a期1例,T3b期4例,T4期1例。所有患者均行^68Ga-PSMA PET-CT检查,由2名核医学专业医生复核SUVmax。原发灶SUVmax(12.49±9.38)。分析SUVmax值与基线PSA、Gleason评分、术后病理情况的关系。结果本研究31例术后ISUP分级:1级3例,2级9例,3级4例,4级6例,5级9例。术后病理分期:T2a期1例,T2c期14例,T3a期6例,T3b期10例。术后病理诊断为切缘阳性19例,阴性12例;脉管癌栓阳性5例,阴性26例;神经侵犯阳性20例,阴性11例。D′Amico危险度分层:低危2例,中危7例,高危22例。按照PSA(≤10 ng/ml或>10 ng/ml)和Gleason评分(≤6分或>6分)分类:低PSA低Gleason评分6例,低PSA高Gleason评分5例,高PSA低Gleason评分9例,高PSA高Gleason评分11例。SUVmax与术后病理ISUP分级具有显著正相关性(r=0.434,P=0.015),与术后病理分期(r=0.232,P=209)、基线PSA(r=0.178,P=0.339)和基线睾酮(r=0.437,P=0.119)无相关性。脉管癌栓阳性组和阴性组的SUVmax分别为14.78±10.^68和8.17±2.81,差异有统计学意义(P=0.005)。病理切缘阳性组和阴性组的SUVmax分别为12.84±7.89和11.79±11.39(P=0.764),神经侵犯阳性组和阴性组的SUVmax分别为22.59±13.72和10.48±6.89(P=0.055),盆腔淋巴结阳性组和阴性组的SUVmax分别为14.50±9.64和12.13±9.32(P=0.639),D′Amico危险度低、中危组和高危组的SUVmax分别为9.39±4.60和13.^68±10.39(P=0.247),差异均无统计学意义。低PSA低Gleason组、低PSA高Gleason组、高PSA低Gleason组、高PSA高Gleason组的SUVmax分别为8.67±4.26、16.70±13.90、9.43±7.75、15.00±9.38,组间差异无统计学意义(P=0.285)。术后病理与穿刺病理ISUP分级相同者19例,SUVmax 11.92±10.61;升级者9例,SUVmax 16.01±5.40;降级者3例,SUVmax 4.98±2.11,3组差异无统计学意义(P=0.287),但升级者SUVmax显著高于降级者(P=0.007)。SUVmax对术后病理ISUP分级的诊断效能受试者工作特征(receiver operating characteristic,ROC)曲线显示,SUVmax对判断术后病理ISUP分级5级的诊断效能最大,曲线下面积0.747(P=0.033);当SUVmax≥11.34时,敏感性可达88.9%,特异性可达77.3%。结论术前^68Ga-PSMA PET-CT中前列腺局部病灶的SUVmax可辅助判断前列腺癌患者是否存在病理预后不良因素,可能具有临床指导意义。     

机器人辅助腹腔镜前列腺癌根治术联合新辅助内分泌治疗高危前列腺癌的临床研究

目的:探讨术前机器人辅助腹腔镜前列腺癌根治术(Robot-assisted laparoscopic radical prostatectomy,RALP)联合新辅助内分泌治疗(Neoadjuvant hormone therapy,NHT)治疗高危前列腺癌患者的临床疗效。方法:回顾性分析甘肃省人民医院泌尿外科自2018年6月-2020年12月前通过PSA、穿刺活检及MRI确诊的35例高危前列腺癌患者临床资料,其中术前行RALP+NHT治疗组25例,年龄为56~81(70.28±7.07)岁;RALP治疗组10例,年龄为49~86(69.20±8.77)岁。比较两组患者的手术时间、术中出血量、术后住院时间、术后切缘阳性率及术中和术后并发症等情况。结果:所有患者手术均获成功,无中转开放及二次手术。与RALP治疗组相比,RALP+NHT治疗组在手术时间[237.88±68.99d Vs (277±76.69)d,P=0.541]、术中出血量[(149.60±149.84)ml Vs (225±268.56)ml,P=0.266]、术后住院时间[(11±4.31) d Vs(11.7±4.86) d,P=0.402]、术后留置尿管时间[(28±6.81) d Vs (28±6.81) d,P=0.464]和术前PSA值[(49.97±32.22)ng/ml Vs (47.41±23.14)ng/ml,P=0.089]等方面差异均无统计学意义;RALP+NHT治疗组在总住院时间[(18.08±4.44)d Vs (25.5±10.82)d,P<0.005]和术后留置引流管时间[(10.12±3.36)d Vs(11.10±5.17)d,P=0.014]明显低于RALP组,差异具有统计学意义;RALP+NHT治疗组在Gleason评分(24%Vs10%)、肿瘤切缘阳性(12%Vs 20%)及并发症(4%Vs 10%)等方面下降明显。结论:术前RALP联合NHT可降低高危前列腺癌切缘阳性、改善病理分级,使高危患者受益。     

腹膜外途径与单孔经膀胱途径前列腺癌根治术治疗低危前列腺癌术后控尿及勃起功能分析

目的:比较保留神经的经腹膜外途径腹腔镜下前列腺癌(PCa)根治术(nsELRP)和经膀胱单孔腹腔镜前列腺癌根治术(TVSSLRP)的手术相关情况及其术后控尿和勃起功能的恢复情况。方法:选取住院治疗符合筛选条件的低危局限性PCa患者50例,随机分为TVSSLRP组和ns ELRP组各25例。收集两组患者以下资料,术前指标:年龄、伴发病、体质指数(BMI)、血清PSA、前列腺体积、穿刺病理Gleason评分、临床分期、IIEF-5评分、阴茎肱动脉压力指数(PBI)及阴茎海绵体动脉血流速度;手术相关指标:手术时间、出血量、输血与否、并发症、手术切缘情况、留置尿管时间、住院日;术后指标:术后病理Gleason评分、病理分期,术后并发症、术后血清PSA、使用尿垫情况、IIEF-5评分、PBI及阴茎海绵体动脉血流速度。结果:两组患者术前一般资料无明显差异,所有手术均顺利完成,无增加辅助通道。手术指标中两组的出血量、输血率、术中并发症及切缘阳性率差异无统计学意义,均未出现术中并发症,手术切缘均为阴性。TVSSLRP组手术时间[(105.92±26.21)min和(151.46±40.68)min]、保留尿管时间[(11.24±1.17)d和(13.01±1.64)d]及住院日[(12.92±4.29)d和(15.76±4.65)d]均明显短于ns ELRP组(P均0.05)。两组患者拔除尿管当日及术后1、3、6个月控尿率分别为84%和52%、100%和84%、100%和96%、100%和96%。术后3、6、12个月勃起功能恢复比率分别为48%和28%、64%和52%、76%和68%,相应IIEF-5评分≥18分,各时间段内TVSSLRP组患者勃起功能恢复比例均更高。所有患者手术前后PBI及阴茎海绵体动脉血流速度差异均无统计学意义。两组术后并发症(Ⅱ级)出现比例分别为32%和40%,差异无统计学意义(P0.05);术后标本病理Gleason评分及临床分期均较术前穿刺病理有升级,但两组间无明显差异(P0.05)。两组术后1年均无生化复发。结论:TVSSLRP术与nsELRP术均适用于低危局限性PCa患者,手术安全,术后恢复快;TVSSLRP术后患者早期控尿功能和勃起功能恢复情况优于nsELRP术。     

Surgical margins in radical prostatectomy: a comparison between retropubic and laparoscopic surgery

Objectives To compare positive surgical margins in both radical retropubic prostatectomies and laparoscopic surgery in two reference centres in Brazil. Materials and methods One hundred and seventy nine pathological studies from patients, who underwent radical prostatectomy due to prostate adenocarcinoma, 89 submitted to retropubic surgery and 90 to laparoscopic surgery, were analyzed. Inclusion criteria Patients with PSA ≤15 ng/ml, and a Gleason score ≤7 at the prostate biopsy, maximum T2 clinical staging. Results There has been surgical margin compromising in 41.57% of the patients submitted to retropubic radical prostatectomy (RRP), 34.21% of which were at pT2 stage and 84.61% were at pT3 stage. In patients submitted to laparoscopic radical prostatectomy (LRP) positive surgical margin was found at 24.44% of the cases: 20.98% of which were at pT2 stage and 55.55% at pT3 stage. Conclusions In the analyzed samples, proportion of positive surgical margin was higher in RRP than in LRP (P = 0.023). A higher number of patients on a randomized prospective study would be necessary for a better comparison between the groups.     

Prognostic significance of tumor volume after radical prostatectomy: a multivariate analysis of pathological prognostic factors

OBJECTIVES: To analyze the association between Gleason score, stage and status of surgical margins with tumor volume in prostate cancer progression after radical prostatectomy. METHODS: 200 consecutive radical prostatectomy specimens were analyzed. Preoperative clinical stage, PSA, results of prostate biopsies as well as pathological results were noted. A biochemical recurrence was defined as a single, postoperative detectable PSA level (>0.2 ng/ml). Tumor volume was compared to postoperative staging, Gleason score, and surgical margin status to predict tumor progression. Univariate and multivariate analysis using stepwise logistic regression were used to identify parameters with additional prognostic value. RESULTS: Pathological results of the prostatectomy specimens showed 149 (74.5%) pT2a-b, 29 (14.5%) pT3a and 22 (11%) pT3b tumors. Tumor volume was 0.57 cc for pT2a, 1.2cc for pT2b, 1.7cc for pT3a and 2.9cc for pT3b, respectively (p<0.05). Taken together, mean volume for pT2 and pT3 were 1.06 and 2.2 cc, respectively (p<0.0001). Five-year progression-free actuarial survival was 69.7%. Using univariate analysis, tumor progression correlated with final Gleason score (p<0.0007), positive surgical margins (p=0.02), tumor volume (p=0.009) and stage (p<0.0001). In a multivariate analysis, tumor progression correlated only with the final Gleason score (p=0.04) and stage (p=0.0002). CONCLUSION: Gleason score and pathological stage are independent factors to predict prostate cancer progression after radical prostatectomy. When these parameters are known, tumor volume does not provide additional information.