Shikanov Sergey A, Thong Alan, Gofrit Ofer N, Zagaja Gregory P, Steinberg Gary D, Shalhav Arieh L, Zorn Kevin C
Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA.
J Endourol. 2008 Jul;22(7):1477-81. doi: 10.1089/end.2008.0091.
We sought to evaluate the pathologic results and postoperative outcomes for men undergoing robot-assisted laparoscopic radical prostatectomy (RLRP) for biopsy Gleason score (GS) 8 to 10 disease. Stratification of these patients according to preoperative variables was also performed in an attempt to predict organ-confined cancer.
A prospective RLRP database identified all patients with preoperative biopsy GS 8 to 10. Variables, including prostate-specific antigen (PSA), percent positive biopsy cores (%PBC), maximal percentage of cancer in biopsy core (%MCB), clinical stage, pathologic stage, pathologic GS, surgical margins status, lymph node status, time to biochemical recurrence, and recurrence rate, were evaluated. Preoperative variables were treated as continuous and categorical using PSA, %PBC and %MCB cutoffs of 10 ng/mL, 50%, and 30%, respectively.
Between February 2003 and September 2007, a total of 1225 RLRPs were performed at the University of Chicago Medical Center. Seventy-two (5.9%) patients had preoperative biopsy GS 8 to 10. Two patients received neoadjuvant hormonal therapy and were excluded. Among 70 patients evaluated, 33 (47%) had organconfined (pT(2)N0) disease. Forty (60.6%) patients had pathologic downgrading to GS <or=7. Overall positive surgical margin (PSM) rate was found to be 24.2%. pT(2)- and pT(3)-PSM rate was 6% and 42.3%, respectively. In multivariate logistic regression analysis, PSA <or=10 ng/mL (P = 0.04) and %MCB <or=30% (P = 0.001) were found to be statistically significant predictors of pT(2)N0 disease.
Preoperative biopsy GS 8 to 10 predicts a significant likelihood of finding non-organ-confined prostate cancer on the final pathology report. Preoperative PSA <or=10 ng/mL and %MCB <or=30% may be used to predict favorable pathologic outcome for these patients during surgical counseling.
我们试图评估接受机器人辅助腹腔镜根治性前列腺切除术（RLRP）治疗活检Gleason评分（GS）为8至10分疾病的男性患者的病理结果和术后结局。还根据术前变量对这些患者进行分层，以试图预测器官局限性癌症。
一个前瞻性RLRP数据库识别出所有术前活检GS为8至10分的患者。评估了包括前列腺特异性抗原（PSA）、活检阳性核心百分比（%PBC）、活检核心中癌症的最大百分比（%MCB）、临床分期、病理分期、病理GS、手术切缘状态、淋巴结状态、生化复发时间和复发率等变量。术前变量分别以PSA、%PBC和%MCB的临界值10 ng/mL、50%和30%作为连续变量和分类变量进行处理。
在2003年2月至2007年9月期间，芝加哥大学医学中心共进行了1225例RLRP手术。72例（5.9%）患者术前活检GS为8至10分。2例患者接受了新辅助激素治疗并被排除。在评估的70例患者中，33例（47%）患有器官局限性（pT(2)N0）疾病。40例（60.6%）患者病理分级降至GS≤7分。总体手术切缘阳性（PSM）率为24.2%。pT(2)期和pT(3)期的PSM率分别为6%和42.3%。在多因素逻辑回归分析中，发现PSA≤10 ng/mL（P = 0.04）和%MCB≤30%（P = 0.001）是pT(2)N0疾病的统计学显著预测因素。
术前活检GS为8至10分预示着最终病理报告中发现非器官局限性前列腺癌的可能性很大。术前PSA≤10 ng/mL和%MCB≤30%可用于在手术咨询期间预测这些患者的良好病理结局。
