根治性前列腺切除术后切缘阳性治疗和预测的最新进展
Recent Advances in the Treatment and Prediction of Positive Surgical Margins after Radical Prostatectomy
DOI: 10.12677/acm.2025.151207, PDF,   
作者: 黄红林：暨南大学第二临床医学院，广东 深圳；张轶庠, 袁也晴：深圳市人民医院泌尿外科(暨南大学附属第二临床医学院、南方科技大学第一附属医院)，广东 深圳
关键词: 前列腺癌；根治性前列腺切除术；切缘阳性；预测；Prostate Cancer； Radical Prostatectomy； Positive Surgical Margin； Prediction
摘要: 前列腺癌是男性恶性肿瘤中最常见的肿瘤之一，目前根治性前列腺切除术是治疗器官局限性及局部进展期前列腺癌的最主要手段。然而在手术后部分患者会出现切缘阳性，这有可能导致前列腺癌的生化复发甚至临床进展，因此有效的治疗和预测策略对改善患者预后至关重要。本文概述切缘阳性患者在根治前列腺切除后的最新诊治及预后，为这类病人的预防和治疗提供思路。
Abstract: Radical prostatectomy is the primary treatment for organ-confined and locally advanced prostate cancer, a malignancy that is one of the most frequent among men. Despite the possibility of positive surgical margins postoperatively, this may result in biochemical recurrence or even a clinical progression of prostate cancer. Therefore, effective treatment and predictive strategies are crucial for improving patient outcomes. The aim of this article is to provide an overview of the most recent progressions in diagnosing, treating, and forecasting those with positive surgical margins after radical prostatectomy, thereby offering insight into how to avert and treat them.
文章引用：黄红林, 张轶庠, 袁也晴. 根治性前列腺切除术后切缘阳性治疗和预测的最新进展[J]. 临床医学进展, 2025, 15(1): 1551-1557. https://doi.org/10.12677/acm.2025.151207

参考文献

[1] Pernar, C.H., Ebot, E.M., Wilson, K.M. and Mucci, L.A. (2018) The Epidemiology of Prostate Cancer. Cold Spring Harbor Perspectives in Medicine, 8, a030361. [Google Scholar] [CrossRef] [PubMed]
[2] Achard, V., Panje, C.M., Engeler, D., Zilli, T. and Putora, P.M. (2021) Localized and Locally Advanced Prostate Cancer: Treatment Options. Oncology, 99, 413-421. [Google Scholar] [CrossRef] [PubMed]
[3] Bill-Axelson, A., Holmberg, L., Garmo, H., Taari, K., Busch, C., Nordling, S., et al. (2018) Radical Prostatectomy or Watchful Waiting in Prostate Cancer—29-Year Follow-Up. New England Journal of Medicine, 379, 2319-2329. [Google Scholar] [CrossRef] [PubMed]
[4] Porcaro, A.B., Sebben, M., Corsi, P., Tafuri, A., Processali, T., Pirozzi, M., et al. (2019) Risk Factors of Positive Surgical Margins after Robot-Assisted Radical Prostatectomy in High-Volume Center: Results in 732 Cases. Journal of Robotic Surgery, 14, 167-175. [Google Scholar] [CrossRef] [PubMed]
[5] Pooli, A., Salmasi, A., Johnson, D.C., et al. (2020) Positive Surgical Margins at Radical Prostatectomy in the United States: Institutional Variations and Predictive Factors. Elsevier.
[6] Tan, P.H., Cheng, L., Srigley, J.R., Griffiths, D., Humphrey, P.A., van der Kwast, T.H., et al. (2011) International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working Group 5: Surgical Margins. Modern Pathology, 24, 48-57. [Google Scholar] [CrossRef] [PubMed]
[7] Ye, H., Kong, X., He, T.W., Jolis, T., Choi, K., Lepor, H., et al. (2011) Intraoperative Frozen Section Analysis of Urethral Margin Biopsies during Radical Prostatectomy. Urology, 78, 399-404. [Google Scholar] [CrossRef] [PubMed]
[8] Bryant, R.J., Schmitt, A.J., Roberts, I.S.D., Gill, P.S., Browning, L., Brewster, S.F., et al. (2015) Variation between Specialist Uropatholgists in Reporting Extraprostatic Extension after Radical Prostatectomy. Journal of Clinical Pathology, 68, 465-472. [Google Scholar] [CrossRef] [PubMed]
[9] Emerson, R.E., Koch, M.O., Daggy, J.K. and Cheng, L. (2005) Closest Distance between Tumor and Resection Margin in Radical Prostatectomy Specimens. American Journal of Surgical Pathology, 29, 225-229. [Google Scholar] [CrossRef] [PubMed]
[10] Bianchi, L., Schiavina, R., Borghesi, M., Casablanca, C., Chessa, F., Mineo Bianchi, F., et al. (2020) Patterns of Positive Surgical Margins after Open Radical Prostatectomy and Their Association with Clinical Recurrence. Minerva Urologica e Nefrologica, 72, 464-473. [Google Scholar] [CrossRef] [PubMed]
[11] Dev, H.S., Wiklund, P., Patel, V., et al. (2015) Surgical Margin Length and Location Affect Recurrence Rates after Robotic Prostatectomy. Elsevier.
[12] Sooriakumaran, P., Dev, H.S., Skarecky, D. and Ahlering, T. (2016) The Importance of Surgical Margins in Prostate Cancer. Journal of Surgical Oncology, 113, 310-315. [Google Scholar] [CrossRef] [PubMed]
[13] Shikanov, S., Song, J., Royce, C., Al-Ahmadie, H., Zorn, K., Steinberg, G., et al. (2009) Length of Positive Surgical Margin after Radical Prostatectomy as a Predictor of Biochemical Recurrence. Journal of Urology, 182, 139-144. [Google Scholar] [CrossRef] [PubMed]
[14] Celik, S., Eker, A., Bozkurt, İ.H., Bolat, D., Basmacı, İ., Şefik, E., et al. (2020) Factors Affecting Biochemical Recurrence of Prostate Cancer after Radical Prostatectomy in Patients with Positive and Negative Surgical Margin. Prostate International, 8, 178-184. [Google Scholar] [CrossRef] [PubMed]
[15] Lee, S., Kim, K.B., Jo, J.K., Ho, J., Oh, J.J., Jeong, S.J., et al. (2016) Prognostic Value of Focal Positive Surgical Margins after Radical Prostatectomy. Clinical Genitourinary Cancer, 14, e313-e319. [Google Scholar] [CrossRef] [PubMed]
[16] Eastham, J.A., Kuroiwa, K., Ohori, M., Serio, A.M., Gorbonos, A., Maru, N., et al. (2007) Prognostic Significance of Location of Positive Margins in Radical Prostatectomy Specimens. Urology, 70, 965-969. [Google Scholar] [CrossRef] [PubMed]
[17] Evren, I., Hacıislamoğlu, A., Ekşi, M., Yavuzsan, A.H., Baytekin, F., Çolakoğlu, Y., et al. (2019) The Impact of Single Positive Surgical Margin Features on Biochemical Recurrence after Robotic Radical Prostatectomy. International Brazilian Journal of Urology, 45, 45-53. [Google Scholar] [CrossRef] [PubMed]
[18] John, A., Lim, A., Catterwell, R., Selth, L. and O’Callaghan, M. (2023) Length of Positive Surgical Margins after Radical Prostatectomy: Does Size Matter?—A Systematic Review and Meta-Analysis. Prostate Cancer and Prostatic Diseases, 26, 673-680. [Google Scholar] [CrossRef] [PubMed]
[19] Mohler, J.L., Armstrong, A.J., Bahnson, R.R., et al. (2016) Prostate Cancer, Version 1.2016. Journal of the National Comprehensive Cancer Network, 14, 19-30.
[20] Mottet, N., Bellmunt, J., Bolla, M., Briers, E., Cumberbatch, M.G., De Santis, M., et al. (2017) EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. European Urology, 71, 618-629. [Google Scholar] [CrossRef] [PubMed]
[21] Leibovich, B.C., Engen, D.E., Patterson, D.E., Pisansky, T.M., Alexander, E.E., Blute, M.L., et al. (2000) Benefit of Adjuvant Radiation Therapy for Localized Prostate Cancer with a Positive Surgical Margin. Journal of Urology, 163, 1178-1182. [Google Scholar] [CrossRef] [PubMed]
[22] Hackman, G., Taari, K., Tammela, T.L., Matikainen, M., Kouri, M., Joensuu, T., et al. (2019) Randomised Trial of Adjuvant Radiotherapy Following Radical Prostatectomy versus Radical Prostatectomy Alone in Prostate Cancer Patients with Positive Margins or Extracapsular Extension. European Urology, 76, 586-595. [Google Scholar] [CrossRef] [PubMed]
[23] Bhindi, B., Carlson, R.E., Mason, R.J., Schulte, P.J., Gettman, M.T., Frank, I., et al. (2017) Long-Term Follow-Up of a Matched Cohort Study Evaluating the Role of Adjuvant Radiotherapy for Organ-Confined Prostate Cancer with a Positive Surgical Margin. Urology, 109, 145-152. [Google Scholar] [CrossRef] [PubMed]
[24] 薛蔚, 董樑, 钱宏阳, 等. 前列腺癌新辅助治疗与辅助治疗的现状及进展[J]. 北京大学学报(医学版), 2023, 55(5): 775-780.
[25] Pisansky, T.M., Thompson, I.M., Valicenti, R.K., D’Amico, A.V. and Selvarajah, S. (2019) Adjuvant and Salvage Radiotherapy after Prostatectomy: ASTRO/AUA Guideline Amendment 2018-2019. Journal of Urology, 202, 533-538. [Google Scholar] [CrossRef] [PubMed]
[26] Yang, C., Wang, H., Hassouna, M.F., Chand, M., Huang, W.J.S. and Chung, H. (2021) Prediction of a Positive Surgical Margin and Biochemical Recurrence after Robot-Assisted Radical Prostatectomy. Scientific Reports, 11, Article No. 14329. [Google Scholar] [CrossRef] [PubMed]
[27] Kim, M.S., Jang, W.S., Chung, D.Y., Koh, D.H., Lee, J.S., Goh, H.J., et al. (2019) Effect of Prostate Gland Weight on the Surgical and Oncological Outcomes of Extraperitoneal Robot-Assisted Radical Prostatectomy. BMC Urology, 19, Article No. 1. [Google Scholar] [CrossRef] [PubMed]
[28] Bismar, T.A., Demichelis, F., Riva, A., Kim, R., Varambally, S., He, L., et al. (2006) Defining Aggressive Prostate Cancer Using a 12-Gene Model. Neoplasia, 8, 59-68. [Google Scholar] [CrossRef] [PubMed]
[29] Liu, J., Zhang, H., Woon, D.T.S., Perera, M. and Lawrentschuk, N. (2024) Predicting Biochemical Recurrence of Prostate Cancer Post-Prostatectomy Using Artificial Intelligence: A Systematic Review. Cancers, 16, Article 3596. [Google Scholar] [CrossRef] [PubMed]
[30] Lee, R.S., Ma, R., Pham, S., Maya-Silva, J., Nguyen, J.H., Aron, M., et al. (2022) Machine Learning to Delineate Surgeon and Clinical Factors That Anticipate Positive Surgical Margins after Robot-Assisted Radical Prostatectomy. Journal of Endourology, 36, 1192-1198. [Google Scholar] [CrossRef] [PubMed]
[31] Eastham, J.A., Kattan, M.W., Riedel, E., Begg, C.B., Wheeler, T.M., Gerigk, C., et al. (2003) Variations among Individual Surgeons in the Rate of Positive Surgical Margins in Radical Prostatectomy Specimens. Journal of Urology, 170, 2292-2295. [Google Scholar] [CrossRef] [PubMed]
[32] Bravi, C.A., Tin, A., Vertosick, E., Mazzone, E., Martini, A., Dell’Oglio, P., et al. (2019) The Impact of Experience on the Risk of Surgical Margins and Biochemical Recurrence after Robot-Assisted Radical Prostatectomy: A Learning Curve Study. Journal of Urology, 202, 108-113. [Google Scholar] [CrossRef] [PubMed]
[33] Langenhuijsen, J.F., van Lin, E.N., Hoffmann, A.L., Spitters-Post, I., Alfred Witjes, J., Kaanders, J.H., et al. (2011) Neoadjuvant Androgen Deprivation for Prostate Volume Reduction: The Optimal Duration in Prostate Cancer Radiotherapy. Urologic Oncology: Seminars and Original Investigations, 29, 52-57. [Google Scholar] [CrossRef] [PubMed]
[34] Hussain, M., Tangen, C.M., Thompson, I.M., Swanson, G.P., Wood, D.P., Sakr, W., et al. (2018) Phase III Intergroup Trial of Adjuvant Androgen Deprivation with or without Mitoxantrone Plus Prednisone in Patients with High-Risk Prostate Cancer after Radical Prostatectomy: SWOG S9921. Journal of Clinical Oncology, 36, 1498-1504. [Google Scholar] [CrossRef] [PubMed]

为你推荐