Salomon Laurent, Anastasiadis Aristotelis G, Johnson Christopher W, McKiernan James M, Goluboff Erik T, Abbou Claude C, Olsson Carl A, Benson Mitchell C
Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Urology. 2003 Aug;62(2):304-9. doi: 10.1016/s0090-4295(03)00373-x.
To evaluate and study the factors for progression after radical prostatectomy with seminal vesicle invasion in a cohort of European and American patients.
The data of 137 patients with isolated seminal vesicle invasion who underwent radical retropubic prostatectomy between 1988 and 2001 were analyzed. The Gleason score of the specimen, presence of capsular invasion, and surgical margin status were noted. Follow-up data were obtained through routine serum prostate-specific antigen (PSA) assays and digital rectal examinations. A defining criterion for progression was a postoperative serum PSA level greater than 0.2 ng/mL or any postoperative radiotherapy or hormonal treatment. Kaplan-Meier analysis was used to determine the actuarial biochemical recurrence-free likelihood, and the log-rank test was used to compare these results. Differences were considered statistically significant when the P value was less than 0.05.
After a mean follow-up of 4.9 years (range 0.9 to 13.4), 70 patients (51.9%) had progression. The biochemical 5-year progression-free survival rate was 33.8%. In univariate and multivariate analyses, only preoperative PSA level (P = 0.001) and Gleason score of the specimen (P = 0.01) were independent predictors of progression. Neither capsular invasion nor positive surgical margins predicted progression. When an analysis was performed according to the major Gleason grade of the radical prostatectomy specimen, Gleason grade 5 was associated with a worse prognosis compared with Gleason grade 3 and 4 (P = 0.01). The mean time to progression was 20.5, 17.1, and 10.1 months for Gleason grade 3, 4, and 5, respectively.
Seminal vesicle invasion after radical prostatectomy has historically been associated with a poor prognosis. However, in the present study, seminal vesicle invasion was associated with a 34% rate of freedom from progression at 5 years after surgery alone. Preoperative PSA and Gleason score of the radical prostatectomy specimen were independent factors for progression in the present study, which described the largest patient group to date. The Gleason grade of the radical prostatectomy specimen distinguished among different times to progression.
评估和研究欧美患者根治性前列腺切除术后伴有精囊侵犯时疾病进展的相关因素。
分析了1988年至2001年间137例接受耻骨后根治性前列腺切除术且伴有孤立性精囊侵犯患者的数据。记录标本的Gleason评分、包膜侵犯情况及手术切缘状态。通过常规血清前列腺特异性抗原（PSA）检测和直肠指检获取随访数据。疾病进展的定义标准为术后血清PSA水平大于0.2 ng/mL或任何术后放疗或激素治疗。采用Kaplan-Meier分析确定精算无生化复发可能性，并用对数秩检验比较结果。当P值小于0.05时，差异被认为具有统计学意义。
平均随访4.9年（范围0.9至13.4年）后，70例患者（51.9%）出现疾病进展。生化无进展5年生存率为33.8%。在单因素和多因素分析中，仅术前PSA水平（P = 0.001）和标本的Gleason评分（P = 0.01）是疾病进展的独立预测因素。包膜侵犯和手术切缘阳性均不能预测疾病进展。根据根治性前列腺切除标本的主要Gleason分级进行分析时，与Gleason 3级和4级相比，Gleason 5级的预后更差（P = 0.01）。Gleason 3级、4级和5级的平均疾病进展时间分别为20.5个月、17.1个月和10.1个月。
根治性前列腺切除术后精囊侵犯在历史上一直与预后不良相关。然而，在本研究中，仅手术治疗后，精囊侵犯与术后5年34%的无进展率相关。在本研究中，术前PSA和根治性前列腺切除标本的Gleason评分是疾病进展的独立因素，本研究描述了迄今为止最大的患者群体。根治性前列腺切除标本的Gleason分级在不同的疾病进展时间上存在差异。
