Pavlovich Christian P, Trock Bruce J, Sulman Aaron, Wagner Andrew A, Mettee Lynda Z, Su Li-Ming
The Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21224, USA.
J Urol. 2008 Mar;179(3):917-21; discussion 921-2. doi: 10.1016/j.juro.2007.10.067. Epub 2008 Jan 22.
We performed a prospective analysis of pathological and oncological outcomes following laparoscopic radical prostatectomy at a medical center in the United States.
A total of 528 men underwent laparoscopic radical prostatectomy between April 2001 and August 2005. We excluded 4 open surgical conversions (0.8%) and 16 men (3.0%) without followup. The remaining 508 men had a mean preoperative prostate specific antigen of 6.0 ng/ml (range 0.3 to 27) and Gleason score of 6.3 (range 6 to 10). Stage was cT1b in 1 case (0.2%), cT1c in 350 (68.9%), cT2a in 135 (26.6%), cT2b in 21 (4.1%) and cT2c in 1 (0.2%). Of the patients 89% underwent cavernous nerve preservation. Biochemical recurrence was defined and timed at the first prostate specific antigen of 0.2 ng/ml or greater if at repeat testing it remained 0.2 ng/ml or greater.
Mean followup was 13.2 months (median 12, range 2 to 52). Pathological stage was pT0N0/Nx in 2 men (0.4%), pT2N0/Nx in 414 (81.5%), pT3aN0/Nx in 72 (14.2%), pT3bN0/Nx in 17 (3.3%) and pT2-3N1 in 3 (0.6%). Positive margin rates increased with higher stage (8.2% in pT2 and 39.3% in pT3 cases, p <0.0001). Three-year actuarial biochemical recurrence-free survival was 98.2% for pT2N0/Nx and 78.7% for pT3N0/Nx/N1 disease (p <0.0001), and it was 94.5% overall. Multivariate analysis controlling for age, preoperative prostate specific antigen, postoperative Gleason score and stage, and margin status showed that only Gleason score (greater than vs less than 7) and stage (pT3 or any N1 vs pT2) predicted biochemical progression.
Laparoscopic radical prostatectomy can provide excellent cancer control outcomes for clinically localized prostate cancer with high actuarial biochemical recurrence-free survival rates at 3 years.
我们在美国一家医疗中心对腹腔镜根治性前列腺切除术后的病理及肿瘤学结果进行了前瞻性分析。
2001年4月至2005年8月期间，共有528名男性接受了腹腔镜根治性前列腺切除术。我们排除了4例开放手术转换病例（0.8%）和16例无随访的男性（3.0%）。其余508名男性术前前列腺特异性抗原平均为6.0 ng/ml（范围0.3至27），Gleason评分平均为6.3（范围6至10）。分期为cT1b的有1例（0.2%），cT1c的有350例（68.9%），cT2a的有135例（26.6%），cT2b的有21例（4.1%），cT2c的有1例（0.2%）。89%的患者进行了海绵体神经保留。生化复发定义为首次前列腺特异性抗原达到0.2 ng/ml或更高，且重复检测时仍保持在0.2 ng/ml或更高。
平均随访时间为13.2个月（中位数12个月，范围2至52个月）。病理分期为pT0N0/Nx的有2例（0.4%），pT2N0/Nx的有414例（81.5%），pT3aN0/Nx的有72例（14.2%），pT3bN0/Nx的有17例（3.3%），pT2 - 3N1的有3例（0.6%）。切缘阳性率随分期升高而增加（pT2病例中为8.2%，pT3病例中为39.3%，p<0.0001）。pT2N0/Nx疾病的3年精算无生化复发生存率为98.2%，pT3N0/Nx/N1疾病的为78.7%（p<0.0001），总体为94.5%。多因素分析控制了年龄、术前前列腺特异性抗原、术后Gleason评分、分期和切缘状态，结果显示只有Gleason评分（大于7分与小于7分）和分期（pT3或任何N1与pT2）可预测生化进展。
腹腔镜根治性前列腺切除术可为临床局限性前列腺癌提供良好的癌症控制效果，3年精算无生化复发生存率较高。
