Shuford Matthew D, Cookson Michael S, Chang Sam S, Shintani Ayumi K, Tsiatis Athanasios, Smith Joseph A, Shappell Scott B
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
J Urol. 2004 Jul;172(1):119-23. doi: 10.1097/01.ju.0000132137.02846.ec.
The prognostic significance of capsular incision (CPI) at radical retropubic prostatectomy remains to be defined. To evaluate this we compared prostate specific antigen recurrence for with CPI to that with established pathological groups.
From January 1998 to December 2000, 409 men underwent radical retropubic prostatectomy at our medical center. CPI was defined as a positive posterior, lateral or posterolateral surgical margin without documented extraprostatic extension (EPE). Excluding patients with preoperative androgen ablation, positive lymph nodes or seminal vesicle involvement there were 129 with organ confined disease and negative surgical margins (pT2/-M), 18 with CPI, 29 with EPE and negative surgical margins (pT3a/-M), and 24 with EPE and positive surgical margins (pT3a/+M). We compared time to biochemical recurrence among these 4 groups using Kaplan-Meier estimates. Cox proportional hazard regression was performed to determine the HR of CPI vs the other groups, while controlling for age, prostate specific antigen, tumor volume and Gleason score.
The 3-year likelihood of freedom from biochemical recurrence in the CPI group was 65%, for pT2/-M it was 96%, for pT3a/-M it was 91% and for pT3a/+M it was 58%. The adjusted HR with the 95% CI showed that the risk of biochemical recurrence with CPI was 8.4 times higher than that with pT2/-M (p = 0.002), 5.9 times higher than that with pT3a/-M (p = 0.046) and the same as that with pT3a/+M (p = 0.840).
Isolated posterior, lateral and posterolateral CPI by our definition occurs not uncommonly and it may represent true incision of the capsule and/or difficulty in diagnosing EPE due to a lack of extraprostatic tissue in the surgical specimen. However, the prognostic significance of CPI as defined appears similar to that of pT3a with positive margins.
耻骨后根治性前列腺切除术中包膜切开术（CPI）的预后意义尚待明确。为评估这一点，我们比较了行CPI患者与既定病理组患者的前列腺特异性抗原复发情况。
1998年1月至2000年12月，409名男性在我们的医疗中心接受了耻骨后根治性前列腺切除术。CPI定义为手术切缘后、外侧或后外侧阳性且无前列腺外侵犯（EPE）记录。排除术前接受雄激素消融、淋巴结阳性或精囊受累的患者后，有129例患者为器官局限性疾病且手术切缘阴性（pT2/-M），18例为CPI，29例为EPE且手术切缘阴性（pT3a/-M），24例为EPE且手术切缘阳性（pT3a/+M）。我们使用Kaplan-Meier估计法比较了这4组患者的生化复发时间。进行Cox比例风险回归以确定CPI与其他组相比的风险比（HR），同时控制年龄、前列腺特异性抗原、肿瘤体积和Gleason评分。
CPI组3年无生化复发的可能性为65%，pT2/-M组为96%，pT3a/-M组为91%，pT3a/+M组为58%。校正后的HR及95%置信区间显示，CPI患者生化复发的风险比pT2/-M组高8.4倍（p = 0.002），比pT3a/-M组高5.9倍（p = 0.046），与pT3a/+M组相同（p = 0.840）。
根据我们的定义，孤立的后、外侧和后外侧CPI并不罕见，它可能代表真正的包膜切开和/或由于手术标本中缺乏前列腺外组织而难以诊断EPE。然而，所定义的CPI的预后意义似乎与切缘阳性的pT3a相似。
