Fromont Gaëlle, Cathelineau Xavier, Rozet François, Prapotnich Dominique, Validire Pierre, Vallancien Guy
Department of Pathology, Institut Montsouris, Paris, France.
J Urol. 2004 Nov;172(5 Pt 1):1845-7. doi: 10.1097/01.ju.0000140266.51848.92.
Since October 2001 we have performed intraoperative frozen section (IFS) on the posterolateral areas of the radical prostatectomy specimen with bilateral nerve sparing. In cases of positive surgical margin (SMs) the corresponding neurovascular bundle (NVB) was resected. We evaluated the impact of several biological and pathological parameters on the incidence of local residual tumor in the NVB.
A total of 487 laparoscopic radical prostatectomies with bilateral nerve sparing and IFS were performed between October 2001 and December 2003. When IFS was positive, the whole NVB was removed and analyzed after fixation in serial sections. The size of the positive SM was measured in its largest dimension. The association of NVB residual tumor with positive SM size, preoperative prostate specific antigen, pathological stage and Gleason score was analyzed using the t and chi-square tests, and logistic regression.
Of the 487 patients 84 had a positive SM on IFS. In 25 of the 84 additionally resected NVBs we found residual tumor. On univariate and multivariate analysis the only predictor of residual tumor was positive SM size (p<0.001). In all cases of a positive SM of 0.1 cm or less we found no residual tumor cells in the NVB.
In case of a positive SM in the posterolateral area of the prostatectomy specimen margin size is predictive of the incidence of residual tumor in the corresponding NVB. This finding could help management and the decision about local adjuvant treatment.
自2001年10月起，我们对保留双侧神经的根治性前列腺切除术标本的后外侧区域进行术中冰冻切片（IFS）检查。手术切缘阳性（SMs）的病例，切除相应的神经血管束（NVB）。我们评估了几种生物学和病理学参数对NVB中局部残留肿瘤发生率的影响。
2001年10月至2003年12月期间，共进行了487例保留双侧神经并进行IFS的腹腔镜根治性前列腺切除术。IFS结果为阳性时，切除整个NVB，固定后制成连续切片进行分析。测量阳性SM的最大尺寸。使用t检验、卡方检验和逻辑回归分析NVB残留肿瘤与阳性SM大小、术前前列腺特异性抗原、病理分期和Gleason评分之间的关联。
487例患者中，84例IFS显示SM阳性。在84例额外切除的NVB中，有25例发现残留肿瘤。单因素和多因素分析显示，残留肿瘤的唯一预测因素是阳性SM大小（p<0.001）。在所有阳性SM为0.1 cm或更小的病例中，我们在NVB中未发现残留肿瘤细胞。
在前列腺切除术标本后外侧区域SM阳性的情况下，切缘大小可预测相应NVB中残留肿瘤的发生率。这一发现有助于指导治疗管理和关于局部辅助治疗的决策。
