Rodríguez-Covarrubias Francisco, Larré Stéphane, Dahan Mickael, De La Taille Alexandre, Allory Yves, Yiou René, Vordos Dimitri, Hoznek Andras, Abbou Claude-Clément, Salomon Laurent
Department of Urology, Henri Mondor University Hospital, Créteil, France.
BJU Int. 2009 Mar;103(6):758-61. doi: 10.1111/j.1464-410X.2008.08096.x. Epub 2008 Oct 16.
To assess the prognostic significance of microscopic bladder neck invasion (BNI+) after radical prostatectomy (RP).
From January 1988 to December 2006, 1480 patients with clinically localized prostate cancer were surgically treated at one tertiary university hospital. The risk of biochemical progression, defined as a prostate-specific antigen (PSA) level after RP of >0.2 ng/mL, was assessed with univariate and multivariate analyses for clinical and pathological variables. We compared the biochemical progression-free survival (bPFS) of patients with BNI+ vs stages pT2, pT3a, pT3b and positive lymph nodes (N+). In a second analysis, we evaluated the bPFS of patients in different stages associated with BNI+ and compared them with those in the same stages with no BNI.
BNI+ was found in 132 (9%) patients; the 5-year bPFS was 86%, 54%, 26% and 10% for stages pT2, pT3a, pT3b and N+, respectively, while it was 30% for BNI+ (P < 0.001). There was no difference in the 5-year bPFS between stage pT2 and pT2 + BNI (P = 0.32). Stages pT3a and pT3b had a better 5-year bPFS than stage pT3a + BNI (P = 0.003) and pT3b + BNI (P = 0.001), respectively. In the univariate analysis all variables were associated with BP. In the multivariate analysis, only BNI+ had no association with BP (odds ratio 1.14, 95% confidence interval 0.70-1.85; P = 0.59).
Microscopic BNI+ in prostate cancer is not an independent risk factor for biochemical progression and should be regarded as a factor that worsens the prognosis of the underlying tumour stage. A longer follow-up is necessary to confirm these findings.
评估根治性前列腺切除术（RP）后显微镜下膀胱颈侵犯（BNI+）的预后意义。
1988年1月至2006年12月，一所三级大学医院对1480例临床局限性前列腺癌患者进行了手术治疗。采用单因素和多因素分析临床及病理变量，评估生化进展风险，生化进展定义为RP后前列腺特异性抗原（PSA）水平>0.2 ng/mL。我们比较了BNI+患者与pT2、pT3a、pT3b期及淋巴结阳性（N+）患者的无生化进展生存期（bPFS）。在第二项分析中，我们评估了与BNI+相关的不同分期患者的bPFS，并将其与相同分期无BNI的患者进行比较。
132例（9%）患者发现BNI+；pT2、pT3a、pT3b和N+期的5年bPFS分别为86%、54%、26%和10%，而BNI+为30%（P<0.001）。pT2期与pT2+BNI期的5年bPFS无差异（P=0.32）。pT3a和pT3b期的5年bPFS分别比pT3a+BNI期（P=0.003）和pT3b+BNI期（P=0.001）更好。单因素分析中所有变量均与BP相关。多因素分析中，只有BNI+与BP无关联（比值比1.14，95%置信区间0.70-1.85；P=0.59）。
前列腺癌显微镜下BNI+不是生化进展的独立危险因素，应被视为一个使基础肿瘤分期预后恶化的因素。需要更长时间的随访来证实这些发现。
