Masieri Lorenzo, Lanciotti Michele, Nesi Gabriella, Lanzi Federico, Tosi Nicola, Minervini Andrea, Lapini Alberto, Carini Marco, Serni Sergio
Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
Urol Int. 2010;85(4):396-400. doi: 10.1159/000315491. Epub 2010 May 28.
The aim of our study was to analyze the role of perineural invasion (PNI) as a predictive parameter of outcome after radical prostatectomy (RRP) in pathologically organ-confined prostate cancer (PCa) and to assess its possible correlation with other well-known prognostic features.
At our institution between January 2000 and December 2007, we prospectively collected data from 251 consecutive patients with pathologically localized PCa after antegrade RRP. In our analysis 239 patients were included. PNI was defined as adenocarcinoma within the perineural space adjacent to a nerve. We evaluated the biochemical progression-free survival rate using the Kaplan-Meier method to establish the correlation between PNI and prognosis, the log-rank test to verify the statistical significance, and χ(2) test to investigate the correlation between PNI and other clinicopathological parameters.
We found intraprostatic PNI in 157 patients (65.7%). The PNI rate was 73% (149/204) in pT2b-c vs. 26% (8/35) in pT2a surgical specimens (p < 0.001), and it was 78.5% (73/93) in patients with a Gleason score of 7-10 vs. 57% (84/146) in a Gleason score of 2-6 (p < 0.01). The mean follow-up was 65.4 (median 62, range 24-118) months. Overall, 11/239 (4.6%) patients presented biochemical recurrence after surgery and 7 (63.6%) of these patients showed PNI, but this was not statistically higher than in patients free from progression (150/228, 65.7%). The actuarial biochemical progression-free survival rate for all patients was 96.9 and 93.5% at 60 and 84 months, respectively, and the stratification based on the presence or absence of PNI did not allow us to identify different prognostic groups.
Perineural infiltration frequently takes part in the pathway of extraprostatic extension. In our series, patients with pathological T2 stages and PNI were found to present a higher pT2 stage and Gleason score, even though our early biochemical-free outcome was not significantly higher than in patients without PNI.
本研究旨在分析神经周围浸润（PNI）在病理分期为器官局限性前列腺癌（PCa）的根治性前列腺切除术（RRP）后作为预后预测参数的作用，并评估其与其他已知预后特征的可能相关性。
2000年1月至2007年12月期间，我们前瞻性收集了251例顺行性RRP术后病理诊断为局限性PCa的连续患者的数据。在我们的分析中纳入了239例患者。PNI定义为神经周围间隙内的腺癌。我们使用Kaplan-Meier方法评估生化无进展生存率，以确定PNI与预后之间的相关性，使用对数秩检验验证统计学意义，并使用χ²检验研究PNI与其他临床病理参数之间的相关性。
我们在157例患者（65.7%）中发现前列腺内PNI。pT2b-c手术标本中的PNI率为73%（149/204），而pT2a手术标本中的PNI率为26%（8/35）（p<0.001）；Gleason评分为7-10分的患者中PNI率为78.5%（73/93），而Gleason评分为2-6分的患者中PNI率为57%（84/146）（p<0.01）。平均随访时间为65.4（中位数62，范围24-118）个月。总体而言，239例患者中有11例（4.6%）术后出现生化复发，其中7例（63.6%）患者存在PNI，但这在统计学上并不高于无进展患者（228例中的150例，65.7%）。所有患者在60个月和84个月时的精算生化无进展生存率分别为96.9%和93.5%，基于PNI存在与否的分层并未使我们能够识别出不同的预后组。
神经周围浸润经常参与前列腺外扩展途径。在我们的系列研究中，病理T2期且存在PNI的患者具有更高的pT2分期和Gleason评分，尽管我们早期的生化无进展结局并不显著高于无PNI的患者。
