Rapp David E, Orvieto Marcelo A, Lucioni Alvaro, Gong Edward M, Shalhav Arieh L, Brendler Charles B
Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
BJU Int. 2005 Nov;96(7):1005-8. doi: 10.1111/j.1464-410X.2005.05768.x.
To evaluate the ability of intra-operative prostate examination (IOPE) to predict extraprostatic extension (EPE) and its effect on margin status in the region of the neurovascular bundle (NVB) when combined with wide excision.
We retrospectively reviewed 403 patients with clinical stage T1c prostate adenocarcinoma undergoing radical retropubic prostatectomy (RRP). All patients had IOPE during RRP, and those with palpable abnormalities in the region of the NVB underwent wide excision. Pathological outcomes were analysed.
Of 403 patients, 49 (12%) had a palpable abnormality in the region of the NVB. After wide excision, 18 (37%) of these 49 patients were found to have EPE at the site of the palpable abnormality; with wide excision of the NVB, only one of these 18 patients (6%) had a corresponding positive surgical margin (PSM). In 354 patients with a normal IOPE and who underwent bilateral NVB preservation, 30 were found to have EPE in the region of the NVB. The PSM rate in this subset was 23% (seven of 30). The positive predictive value of IOPE for detecting EPE was 37%.
IOPE detects abnormalities in 12% of patients with preoperative stage T1c prostate cancer. Although the predictive value of this test is limited, IOPE may decrease PSMs in a subset of patients with EPE in the region of the NVB. The present study reaffirms the value of IOPE for assessing the risk of extraprostatic disease, and for guiding surgical management.
评估术中前列腺检查（IOPE）预测前列腺外侵犯（EPE）的能力，以及在联合广泛切除时其对神经血管束（NVB）区域切缘状态的影响。
我们回顾性分析了403例临床分期为T1c期前列腺腺癌并接受耻骨后根治性前列腺切除术（RRP）的患者。所有患者在RRP过程中均接受了IOPE，NVB区域可触及异常的患者接受了广泛切除。对病理结果进行分析。
403例患者中，49例（12%）NVB区域可触及异常。广泛切除后，这49例患者中有18例（37%）在可触及异常部位发现有EPE；在广泛切除NVB的情况下，这18例患者中只有1例（6%）有相应的手术切缘阳性（PSM）。在354例IOPE正常且保留双侧NVB的患者中，30例在NVB区域发现有EPE。该亚组的PSM率为23%（30例中的7例）。IOPE检测EPE的阳性预测值为37%。
IOPE在12%的术前T1c期前列腺癌患者中检测到异常。尽管该检查的预测价值有限，但IOPE可能会降低NVB区域有EPE的部分患者的PSM。本研究再次证实了IOPE在评估前列腺外疾病风险及指导手术管理方面的价值。
