摘要
目的探讨术前^(68)Ga-PSMA PET/CT检查对高危前列腺癌患者手术策略的指导及对术后切缘阳性的影响。方法回顾性分析2019年6月至2020年12月空军军医大学西京医院行机器人辅助腹腔镜根治性前列腺切除术的118例高危前列腺癌患者的临床资料,其中47例术前行^(68)Ga-PSMA PET/CT检查,为研究组;71例术前未行^(68)Ga-PSMA PET/CT检查,为对照组。研究组与对照组年龄[69(63,76)岁与67(64,74)岁]、前列腺特异性抗原(PSA)[PSA≤20ng/ml:9.91(6.00,13.67)ng/ml与11.64(8.15,15.44)ng/ml,PSA>20ng/ml:66.53(53.66,195.30)ng/ml与63.18(30.08,148.05)ng/ml]、术前临床分期(T2期/≥T3期:21/26例与34/37例)、穿刺Gleason评分[8(7,9)分与8(7,9)分]差异均无统计学意义(P>0.05)。研究组术前PSMA PET/CT检查发现淋巴结转移11例,对照组MRI检查发现淋巴结转移26例。两组均行机器人辅助腹腔镜根治性前列腺切除术。研究组根据PSMA PET/CT结果、对照组根据MRI结果确定手术方案,首先保证全部切除肿瘤,其次尽可能保留患者尿道长度以保证术后尿控;若有精囊侵犯,则根据需要扩大切除范围;若显示淋巴结转移,则行淋巴结清扫术。对于影像学检查淋巴结阴性者,若术中发现肿大淋巴结,也行淋巴结清扫术。比较两组患者围手术期结果及手术切缘情况,分析PSA值与前列腺癌组织SUVmax值的相关性。结果两组手术均顺利完成,无中转开放手术。研究组手术时间短于对照组[175(155,205)min与205(155,235)min,P=0.003],切缘阳性率显著低于对照组[23.40%(11/47)与45.07%(32/71),P=0.017]。病理分期≥pT3期患者中,研究组切缘阳性率显著低于对照组[30.77%(8/26)与62.16%(23/37),P=0.014]。研究组术前PSMA-PET显示淋巴结阳性11例中,术后病理阳性10例(90.91%);PSMA-PET显示淋巴结阴性者中行淋巴结清扫1例,术后病理阳性。对照组26例行淋巴结清扫,术后病理阳性16例(61.54%)。研究组47例术前PSA值与前列腺癌组织SUVmax值呈正相关(r=0.579,P<0.01)。结论高危前列腺癌患者术前行^(68)Ga-PSMA PET/CT检查,可以指导外科医生优化手术方案、精准切除,降低术后切缘阳性率,有效切除转移淋巴结,使患者获益。
Objective To explore the preoperative ^(68)Ga-PSMA PET/CT examination on the guidance of surgical strategies for high-risk prostate cancer patients and the influence of positive surgical margins after surgery.Methods The clinical data of 118 patients with high-risk prostate cancer who underwent robot-assisted laparoscopic radical prostatectomy from June 2019 to December 2020 in Xijing Hospital of Air Force Military Medical University was retrospectively analyzed.47 patients received ^(68)Ga-PSMA PET/CT examination before surgery(study group),and 71 cases without ^(68)Ga-PSMA PET/CT examination before operation(control group).There was no statistically significant difference in the age[69(63,76)vs.67(64,74)years],PSA[PSA≤20ng/ml:9.91(6.00,13.67)vs.11.64(8.15,15.44)ng/ml,PSA>20ng/ml:66.53(53.66,195.30)vs.63.18(30.08,148.05)ng/ml],preoperative clinical staging(T2/≥T3:21/26 cases vs.34/37 cases),and Gleason score[8(7,9)vs.8(7,9)points](all P>0.05)between study group and control group.Both groups underwent robot-assisted laparoscopic radical prostatectomy.The surgical plan was based on the PSMA PET/CT and MRI results in study group and control group respectively.First,ensure that all tumors are removed,and secondly,preserve the patient's urethral length as much as possible to ensure postoperative urinary control.If there is seminal vesicle invasion,expand the scope of resection as needed.If lymph node metastasis is shown,lymph node dissection is performed.For those with negative lymph nodes in imaging studies,if enlarged lymph nodes are found during the operation,lymph node dissection is also performed.After the operation,the perioperative results and surgical margins of the two groups were compared,and the correlation between the PSA value and the SUVmax value of prostate cancer tissue was analyzed.Results The operations of the two groups were successfully completed,and there was no transfer to open surgery.The operation time of the study group was shorter than that of the control group[175(155,205)min vs.205(155,235)min,P=0.003],and the positive rate of resection margin was significantly lower than that of the control group[23.40%(11/47)vs.45.07%(32/71),P=0.017].For patients with pathological stage≥pT3,the positive rate of surgical margins in the study group was significantly lower than that in the control group[30.77%(8/26)vs.62.16%(23/37),P=0.014].In the study group,11 cases of PSMA-PET showed positive lymph nodes before operation,10 cases were pathologically positive after operation(90.91%).PSMA-PET showed negative lymph nodes in 1 case,which was pathologically positive after operation.In the control group,26 cases underwent lymph node dissection,and 16 cases(61.54%)were pathologically positive after operation.The preoperative PSA value of 47 cases in the study group was positively correlated with the SUVmax value of prostate cancer tissue(r=0.579,P<0.01).Conclusions Preoperative ^(68)Ga-PSMA PET/CT for high-risk prostate cancer patients can guide the surgeon to optimize the surgical plan,reduce the positive rate of resection margins,and effectively remove the metastatic lymph nodes,which will benefit the patients.
作者
权鹏鹤
于长江
范效铮
张龙龙
焦健华
苏醒
马帅军
武鹏
秦卫军
杨晓剑
Quan Penghe;Yu Changjiang;Fan Xiaozheng;Zhang Longlong;Jiao Jianhua;Su Xing;Ma Shuaijun;Wu Peng;Qin Weijun;Yang Xiaojian(Department of Urology,Xijing Hospital,Air Force Military Medical University,Xi'an 710032,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2021年第9期706-711,共6页
Chinese Journal of Urology
