Chuang Ai-Ying, Nielsen Matthew E, Hernandez David J, Walsh Patrick C, Epstein Jonathan I
Department of Pathology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
J Urol. 2007 Oct;178(4 Pt 1):1306-10. doi: 10.1016/j.juro.2007.05.159. Epub 2007 Aug 14.
The significance of capsular incision into tumor at radical prostatectomy with otherwise organ confined tumor is not well understood.
Inclusion criteria were positive margin in an area of capsular incision, no extraprostatic extension elsewhere, negative seminal vesicles and lymph nodes, entire prostate submitted for examination, and no neoadjuvant therapy.
The postoperative progression of 135 cases of radical prostatectomy with capsular incision (1.3% of radical prostatectomies 1993 to 2004) was compared to 10,311 radical prostatectomies without capsular incision. Mean tumor length at the capsular incision site was 2.6 mm. Capsular incision was posterolateral (61.5%), posterior (18.5%), anterior (8.9%), lateral (8.1%) and apical (3%). The 5-year actuarial freedom from biochemical recurrence for tumors with capsular incision was worse (71.3%) than organ confined margin negative tumor (96.7%) (p <0.0001) and focal extraprostatic extension margin negative disease (89.7%) (p = 0.02), yet better than extensive extraprostatic extension margin positive tumors (58.5%) (p <0.0001). The risks of progression in men with capsular incision, focal extraprostatic extension margin positive and extensive extraprostatic extension margin negative disease were not significantly different. Risk of recurrence correlated with tumor length at the capsular incision site (p = 0.002). The 5-year risks of biochemical progression were 20.0% and 55% for less than 3 mm and 3 mm or greater of tumor cut across, respectively.
Isolated capsular incision into tumor is uncommon in cases of radical prostatectomy performed by experienced urologists, typically Gleason score 6, and most common in the neurovascular bundle region. Isolated capsular incision has a higher recurrence rate than organ confined or focal extraprostatic extension margin negative disease, yet a lower recurrence rate than extensive extraprostatic extension margin positive tumor, and a worse prognosis with greater extent of capsular incision.
在根治性前列腺切除术中，对于原本局限于器官内的肿瘤进行包膜切开进入肿瘤的意义尚未完全明确。
纳入标准为包膜切开区域切缘阳性，其他部位无前列腺外侵犯，精囊和淋巴结阴性，整个前列腺送检，且未接受新辅助治疗。
将135例进行包膜切开的根治性前列腺切除术病例（占1993年至2004年根治性前列腺切除术的1.3%）的术后进展情况与10311例未进行包膜切开的根治性前列腺切除术病例进行比较。包膜切开部位肿瘤的平均长度为2.6毫米。包膜切开部位为后外侧（61.5%）、后方（18.5%）、前方（8.9%）、外侧（8.1%）和尖部（3%）。包膜切开的肿瘤5年生化无复发生存率（71.3%）低于局限于器官内切缘阴性的肿瘤（96.7%）（p<0.0001）和局灶性前列腺外侵犯切缘阴性疾病（89.7%）（p = 0.02），但高于广泛性前列腺外侵犯切缘阳性肿瘤（58.5%）（p<0.0001）。包膜切开、局灶性前列腺外侵犯切缘阳性和广泛性前列腺外侵犯切缘阴性疾病患者的进展风险无显著差异。复发风险与包膜切开部位肿瘤长度相关（p = 0.002）。肿瘤横径小于3毫米和3毫米及以上的患者5年生化进展风险分别为20.0%和55%。
在经验丰富的泌尿外科医生进行的根治性前列腺切除术中，孤立性包膜切开进入肿瘤的情况并不常见，通常为Gleason评分6分，最常见于神经血管束区域。孤立性包膜切开的复发率高于局限于器官内或局灶性前列腺外侵犯切缘阴性疾病，但低于广泛性前列腺外侵犯切缘阳性肿瘤，且包膜切开范围越大预后越差。
