前列腺癌根治性切除术后切缘阳性部位与术后生化复发相关性分析

Analysis of the Correlation between Positive Margin Sites and Postoperative Biochemical Recurrence after Radical Prostatectomy for Prostate Cancer

摘要: 目的：评估前列腺癌根治性切除术后切缘阳性部位对患者术后生化复发的影响。方法：对青岛大学附属医院2017年1月~2021年6月行腹腔镜下前列腺癌根治术的符合纳入标准的336例患者进行随访，采用Kaplan-Meier法分析不同切缘状态(包括切缘阴性、单灶性尖部切缘阳性、单灶性基底部切缘阳性、多灶性切缘阳性)下患者术后无生化复发生存期的差异，采用单因素和多因素Cox比例风险模型分析生化复发与不同切缘状态、年龄、术前PSA，前列腺体积，术后病理分期，术后病理Gleason评分，是否行淋巴清扫术，是否精囊侵犯，是否神经侵犯、是否血管侵犯的关系。结果：单因素分析显示单纯尖部切缘阳性、单纯基底部切缘阳性、多灶性切缘阳性、神经侵犯、血管侵犯、精囊侵犯、术前PSA、和病理Gleason评分与前列腺癌术后复发显著相关。未发现年龄、前列腺体积、淋巴结清扫的显著影响。多因素分析显示，术前PSA、术后病理分期、术后病理Gleason评分、单纯基底部切缘阳性、多灶性切缘阳性是生化复发的独立预测因素。结论：在切缘阳性的部位中，单灶性基底部切缘阳性与多灶性切缘阳性是生化复发的独立预测因素，单灶性尖部切缘阳性与较差的生化复发有关，但经多因素分析，它并不是生化复发的独立预测因素。切缘阳性与术后生化复发显著相关，但同时应考虑到不同切缘阳性部位预后意义的差异。

Abstract: Objective: To assess the impact of positive margin sites after radical prostatectomy for prostate cancer on postoperative biochemical recurrence in patients. Methods: The data of 336 patients who underwent laparoscopic radical prostatectomy for prostate cancer and met the inclusion criteria in the Affiliated Hospital of Qingdao University from January 2017 to June 2021 were followed up, and the differences in postoperative survival without biochemical recurrence among patients with different margin status (including margin negative, unifocal apical margin positive, unifocal basal margin positive, and multifocal margin positive) were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox proportional risk models were used to analyze the relationship between biochemical recurrence and different margin status, age, preoperative PSA, prostate volume, postoperative pathological staging, postoperative pathological Gleason scores, whether lymphatic clearance was performed, whether seminal vesicle invasion was present, whether there was neurological invasion, and whether there was vascular invasion. Results: Univariate analysis showed that a positive apical margin alone, a positive basal margin alone, a positive multifocal margin, nerve invasion, vascular invasion, seminal vesicle invasion, preoperative PSA, and pathologic Gleason score were significantly associated with postoperative prostate cancer recurrence. No significant effect of age, prostate volume, or lymph node dissection was found. Multifactorial analysis showed that preoperative PSA, postoperative pathological staging, postoperative pathological Gleason score, positive simple basal margins, and positive multifocal margins were independent predictors of biochemical recurrence. Conclusions: Among the margin-positive sites, unifocal basal margin positivity versus multifocal margin positivity was an independent predictor of biochemical recurrence, and unifocal apical margin positivity was associated with poorer biochemical recurrence, but it was not an independent predictor of biochemical recurrence by multifactorial analysis. Positive margin was significantly associated with postoperative biochemical recurrence, but differences in the prognostic significance of different positive margin sites should also be taken into account.