摘要
目的 探讨良性前列腺增生（BPH）术后发现前列腺偶发癌（incidental prostate cancer,IPCa）患者接受根治性前列腺切除术（radical prostatectomy,RP）后的长期疗效,分析IPCa患者行BPH手术后前列腺癌残留及RP术后生化复发的危险因素.方法 回顾性分析2004年1月至2016年10月我院收治的45例IPCa患者的临床病理及随访资料,患者均为BPH术后病理诊断为前列腺癌并接受RP.包括年龄、BPH术前及术后的PSA、前列腺体积、BPH术后前列腺癌T分期（T1a、T1b）及Gleason评分、RP术后前列腺癌T分期（pT0、pT2、pT3）及Gleason评分、生化复发情况.通过Logistic多元回归分析与BPH术后前列腺癌残留相关的因素,应用Cox回归分析RP术后生化复发的危险因素.结果 45例患者中T1a期21例,T1b期24例,其中7例（15.6％） BPH术后无前列腺癌残留,即为pT0期.logistic回归多因素分析结果显示,BPH术前PSA（RR =2.58,95％ CI 1.27 ～ 5.42,P=0.04）、BPH术后PSA（RR =4.26,95％ CI2.57 ～7.64,P=0.01）及BPH术后Gleason评分（RR =3.98,95％ CI1.85 ～5.77,P =0.02）是显著影响BPH术后前列腺癌残留的相关因素.术后随访5～44个月,平均54个月.5年和10年的总体无生化复发生存率分别为95.6％和86.7％.多因素Cox回归分析结果显示BPH术后PSA（RR=4.79,95％ CI2.57 ～ 7.64,P=0.02）及BPH术后Gleason评分（RR =2.01,95％ CI 1.74 ～5.21,P=0.04）是RP术后生化复发的独立危险因素.而BPH术后T分期（T1a、T1b）与BPH术后前列腺癌残留及RP术后生化复发无明显相关性（均P＞0.05）.结论 BPH术后发现IPCa的患者接受RP可获得良好的长期肿瘤控制效果,BPH术前PSA、BPH术后PSA及BPH术后Gleason评分是显著影响BPH术后前列腺癌残留的相关因素,而BPH术后PSA和RP术后Gleason评分是影响RP术后生化复发的独立危险因素.
Objective To investigate the long-term outcome of radical prostatectomy （RP） in the patients with incidental prostate cancer （IPCa） detected by surgery of benign prostatic hyperplasia （BPH） and to evaluate the risk factors for residual tumour after BPH surgery and biochemical recurrence in patients with IPCa treated with RP.Methods We retrospectively analyzed the clinical and follow-up data of 45 patients with IPCa detected by surgery of BPH and undergoing RP from January 2004 to October 2016.The age,PSA before and after BPH surgery,prostate volume,T stage and Gleason score after the BPH surgery,T stage at RP （pT0,pT2,pT3）,Gleason score at RP and status of biochemical recurrence were recorded.Multivariate logistic regression analysis addressed the association between the factors and the presence of residual cancer after the surgery for BPH.Cox regression was used to analyzed the relationship between the factors and the rate of biochemical recurrence after RP.Results Among 45 IPCa patients,21 patients were stage T1a and 24 were stage T1b.After RP,7 （15.6%） patients had no residual tumor （pT0）.PSA before BPH surgery （RR =2.58,95% CI 1.27-5.42,P =0.04）,PSA after BPH surgery （RR =4.26,95% CI 2.57-7.64,P =0.01） and Gleason score after BPH surgery （RR =3.98,95% CI 1.85-5.77,P =0.02） were significant associated factors with the residual cancer after BPH surgery.With a mean follow-up of 54 months（ranging 5-144 months）,the 5-and 10-years.biochemical recurrence-free survival rates were 95.6% and 86.7%,respectively.PSA after surgery for BPH （RR =4.79,95% CI 2.57-7.64,P =0.02） and Gleason score after RP（RR =2.01,95% CI 1.74-5.21,P =0.04） were the only independent risk factors for biochemical recurrence.Stage （T1a-T1b） did not predict residual cancer or the rate of biochemical recurrence （P 〉 0.05）.Conclusions RP in the patients with IPCa detected by BPH surgery had a good outcome of long-term oncological control.PSA before and after BPH surgery and Gleason score at BPH surgery were the significant associated factors of residual cancer after BPH surgery.PSA after BPH surgery and Gleason score at RP were the only independent risk factors for biochemical recurrence.
作者
高超
杨文增
崔振宇
郭景阳
宋士超
Gao Chao Yang Wenzeng Cui Zhenyu Guo Jingyang Song Shichao(Department of Urology, Affiliated Hospital of Hebei University, Baoding 071000, China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2017年第9期702-706,共5页
Chinese Journal of Urology
关键词
前列腺肿瘤
偶发癌
根治性前列腺切除术
生化复发
Prostatic neoplasms
Incidental cancer
Radical prostatectomy
Biochemical recurrence
