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。

Laparoscopic radical prostatectomy in the treatment of localized prostate cancer:A comparative study of pre-and post-operative pathological features

Objective To compare the changes of Gleason scores before and after laparoscopic radical prostatectomy in patients with localized prostate cancer, and to analyze the risk factors for escalaed Gleason scores in the low-risk group. Methods The clinicopathological data of patients with localized prostate cancer undergoing laparoscopic radical prostatecto my were retrospectively analyzed. Patients, age,prostate volume,PSA,number of biopsy needles,positive needle count,Gleason score of tissue biopsy,cTNM, postoperative Gleason score and pTNM were collected. The patients were divided into different risk groups. Results A total of 346 patients were involved,including 63 in the low-risk group, 163 in the intermediate-risk group,and 120 in the high-risk group. After operation,23 patients (35.93%) in the low-risk group,37 patients (22.70%) in the intermediate-risk group,and 41 patients (34. 17%) in the high-risk group had upgraded Gleason score. In the low-risk group, there were significant differences in PSA level,positive puncture rate and prostate volume between patients with upgraded and non-upgraded Gleason score (P<0.05). Multivariate Logistic regression analysis showed that small prostate volume and high preoperative PSA level were independent risk factors for pathological upgrade after laparoscopic radical prostatectomy ( P< 0. 05). C on elusion The preoperative Gleason score is significantly underestimated compared with the postoperative score. Low-risk patients with small prostate volume and high preoperative PSA level may be more suitable for surgical treatment.