Rodriguez-Covarrubias F, Larré S, Dahan M, De La Taille A, Allory Y, Yiou R, Vordos D, Hoznek A, Abbou C-C, Salomon L
Department of Urology, Henri Mondor University Hospital, Créteil, France.
Prostate Cancer Prostatic Dis. 2008;11(3):294-7. doi: 10.1038/sj.pcan.4501009. Epub 2007 Sep 18.
The aim of the study was to evaluate factors of progression after radical prostatectomy in patients with bladder neck invasion (BNI). From 1988 to 2006, 1395 patients underwent radical prostatectomy, 120 (8.6%) had microscopic BNI (pT4 N0, TNM 2002). Group 1 was defined as BNI alone, group 2 as BNI plus extracapsular extension and group 3 as BNI plus seminal vesicle invasion (SVI). Postoperative follow-up data were obtained through routine serum prostate-specific antigen (PSA) and digital rectal examination. Biochemical progression was defined as a single detectable PSA level postoperatively (>0.2 ng ml(-1)). Groups 1, 2 and 3 included 38 (31%), 35 (30%) and 47 (39%) patients, respectively. Preoperative PSA (11.1 vs 24.7 and 23.3 ng ml(-1), P=0.01), biopsy Gleason score (5 vs 6 and 6, P=0.003) and specimen Gleason score (6 vs 7 and 7, P=0.02) were statistically different between three groups. None of the patients had a specimen Gleason score >or=8 in group 1. After a mean follow-up of 27 months, 51 (42.5%) patients had biochemical progression. The 5-year progression-free survival was 87, 53 and 17% for groups 1, 2 and 3, respectively (P<0.001). Within pT4 prostate cancer, those tumors with isolated microscopic BNI appear to have better prognosis than those with associated extracapsular extension and/or seminal vesicle invasion, and should be distinguished in TNM classification.
本研究的目的是评估膀胱颈浸润（BNI）患者根治性前列腺切除术后的进展因素。1988年至2006年，1395例患者接受了根治性前列腺切除术，其中120例（8.6%）有微观BNI（pT4 N0，2002年TNM分期）。第1组定义为单纯BNI，第2组为BNI加包膜外侵犯，第3组为BNI加精囊侵犯（SVI）。术后随访数据通过常规血清前列腺特异性抗原（PSA）和直肠指检获得。生化进展定义为术后单次可检测到的PSA水平（>0.2 ng/ml）。第1、2和3组分别包括38例（31%）、35例（30%）和47例（39%）患者。三组之间术前PSA（11.1 vs 24.7和23.3 ng/ml，P=0.01）、活检Gleason评分（5 vs 6和6，P=0.003）和标本Gleason评分（6 vs 7和7，P=0.02）在统计学上有差异。第1组中没有患者的标本Gleason评分≥8。平均随访27个月后，51例（42.5%）患者出现生化进展。第1、2和3组的5年无进展生存率分别为87%、53%和17%（P<0.001）。在pT4期前列腺癌中，那些仅有微观BNI的肿瘤似乎比伴有包膜外侵犯和/或精囊侵犯的肿瘤预后更好，应在TNM分类中加以区分。
