Xylinas Evanguelos, Drouin Sarah J, Comperat Eva, Vaessen Christophe, Renard-Penna Raphaële, Misrai Vincent, Bitker Marc-Olivier, Chartier-Kastler Emmanuel, Richard François, Cussenot Olivier, Roupret Morgan
Department of Urology, GHU EST (Pitiè-Tenon), Assistance-Publique Hôpitaux de Paris, Paris, France.
BJU Int. 2009 May;103(9):1173-8; discussion 1178. doi: 10.1111/j.1464-410X.2008.08208.x. Epub 2008 Nov 25.
To determine the effectiveness of cancer control afforded by radical prostatectomy (RP) in patients with clinical stage T3 prostate cancer.
We retrospectively reviewed data for patients treated by RP for clinical stage T3 prostate cancer between 1995 and 2005. The following case characteristics were analysed: patient age, clinical presentation, preoperative prostate-specific antigen (PSA) level, Gleason score, tumour stage (2002 Tumour-Node-Metastasis), surgical procedure, pathological data, margin and lymph node status, and recurrence. Biochemical recurrence was defined as an increase in PSA level of >0.2 ng/mL after surgery. Kaplan-Meier survival curves were generated, and prognostic factors were evaluated.
Overall, 100 patients were included; only 79% of them had pT3 disease based on the pathological specimen. The median follow-up after RP was 69 months. The RP was open in 77 and laparoscopic in 23, with no significant difference between these approaches (P = 0.38). The 5-year PSA-free survival after surgery was 45%, and 5-year cancer-specific survival was 90%. On univariable analysis, Gleason score >7 (P = 0.01), pathological stage (pT2-T3a vs T3b) (P < 0.001), positive lymph node (P < 0.001), and positive margin (P < 0.001) were associated with recurrence. On multivariable analysis, lymph node, margin status and Gleason score were also significant (P < 0.05).
RP can be recommended as an alternative primary treatment that results in acceptable cancer control for clinical stage T3 prostate cancer in selected cases. However, the patient should be warned that surgery alone might not be sufficient to control the cancer, and that adjuvant therapy might be needed during the course of the disease.
确定根治性前列腺切除术（RP）对临床分期为T3期前列腺癌患者的癌症控制效果。
我们回顾性分析了1995年至2005年间接受RP治疗的临床分期为T3期前列腺癌患者的数据。分析了以下病例特征：患者年龄、临床表现、术前前列腺特异性抗原（PSA）水平、Gleason评分、肿瘤分期（2002年肿瘤-淋巴结-转移分期）、手术方式、病理数据、切缘及淋巴结状态以及复发情况。生化复发定义为术后PSA水平升高>0.2 ng/mL。绘制了Kaplan-Meier生存曲线，并评估了预后因素。
总体纳入100例患者；根据病理标本，其中仅79%患有pT3期疾病。RP术后的中位随访时间为69个月。77例行开放手术，23例行腹腔镜手术，两种手术方式之间无显著差异（P = 0.38）。术后5年无PSA生存为45%，5年癌症特异性生存为90%。单因素分析显示，Gleason评分>7（P = 0.01）、病理分期（pT2-T3a与T3b）（P < 0.001）、淋巴结阳性（P < 0.001）及切缘阳性（P < 0.001）与复发相关。多因素分析显示，淋巴结、切缘状态及Gleason评分也具有显著性（P < 0.05）。
对于部分临床分期为T3期前列腺癌患者，RP可作为一种替代的初始治疗方法，其癌症控制效果尚可接受。然而，应告知患者，单纯手术可能不足以控制癌症，在疾病过程中可能需要辅助治疗。
