对于临床局限性前列腺癌，孤立性精囊侵犯在耻骨后根治性前列腺切除术后预后更佳：根据淋巴结和切缘状态对pT3b期疾病进行预后分层

Isolated seminal vesicle invasion imparts better outcomes after radical retropubic prostatectomy for clinically localized prostate cancer: prognostic stratification of pt3b disease by nodal and margin status.

作者信息

Masterson Timothy A, Pettus Joseph A, Middleton Richard G, Stephenson Robert A

机构信息

Division of Urology, Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA.

出版信息

Urology. 2005 Jul;66(1):152-5. doi: 10.1016/j.urology.2005.01.014.

DOI:10.1016/j.urology.2005.01.014

PMID:15992904

Abstract

OBJECTIVES

To examine the survival differences in men with seminal vesicle invasion (SVI) according to surgical margin (SM) and nodal (N) status to characterize the influence of isolated SVI on disease progression after radical retropubic prostatectomy for clinically localized prostate cancer.

METHODS

We reviewed the records of 941 men who underwent radical retropubic prostatectomy for clinically localized prostate cancer between 1984 and 2002. Three groups with evidence of SVI (SM-/N-, SM+/N-, and N+) were analyzed to identify differences in age, preoperative prostate-specific antigen (PSA) level, biopsy Gleason score, surgical Gleason score, time to PSA progression, follow-up time, and cancer-specific and overall survival. Kaplan-Meier estimates and univariate and multivariate calculations were generated to examine differences in biochemical-free survival.

RESULTS

Of 941 patients, 87 were identified with SVI; of these, 28 (32.2%) were SM-/N-, 35 (40.2%) were SM+/N-, and 24 (27.6%) were N+. The median follow-up for all patients was 70 months. The 5-year biochemical progression-free rate for SM-/N-, SM+/N-, and N+ patients was 71.9%, 36.6%, and 25.9%, respectively. The median time to PSA progression for SM-/N-, SM+/N-, and N+ patients was 26, 16, and 6 months, respectively. The clinical stage, pretreatment PSA level, and margin and node status were statistically predictive (P < 0.05) on univariate analyses; however, only positive margin status approached statistical significance on multivariate analysis (P = 0.06). The overall and cancer-specific 5-year survival rates for SM-/N-, SM+/N-, and N+ patients were 89% and 100%, 79% and 97%, and 78% and 86%, respectively.

CONCLUSIONS

Isolated SVI is associated with lower rates of, and longer intervals to, biochemical failure compared with SVI with positive margins and/or regional lymph node involvement.

摘要

目的

根据手术切缘（SM）和淋巴结（N）状态，研究精囊侵犯（SVI）男性患者的生存差异，以明确孤立性SVI对临床局限性前列腺癌耻骨后根治性前列腺切除术后疾病进展的影响。

方法

我们回顾了1984年至2002年间941例行耻骨后根治性前列腺切除术治疗临床局限性前列腺癌男性患者的记录。分析了三组有SVI证据的患者（SM-/N-、SM+/N-和N+），以确定年龄、术前前列腺特异性抗原（PSA）水平、活检Gleason评分、手术Gleason评分、PSA进展时间、随访时间以及癌症特异性生存率和总生存率的差异。采用Kaplan-Meier估计法以及单因素和多因素计算来检验无生化进展生存率的差异。

结果

941例患者中，87例被确定有SVI；其中，28例（32.2%）为SM-/N-，35例（40.2%）为SM+/N-，24例（27.6%）为N+。所有患者的中位随访时间为70个月。SM-/N-、SM+/N-和N+患者的5年无生化进展率分别为71.9%、36.6%和25.9%。SM-/N-、SM+/N-和N+患者的PSA进展中位时间分别为26个月、16个月和6个月。单因素分析显示，临床分期、治疗前PSA水平以及切缘和淋巴结状态具有统计学预测性（P<0.05）；然而，多因素分析中只有阳性切缘状态接近统计学意义（P = 0.06）。SM-/N-、SM+/N-和N+患者的5年总生存率和癌症特异性生存率分别为89%和100%、79%和97%、78%和86%。