Alkhateeb Sultan Saud, Alibhai Shabbir M, Finelli Antonio, Fleshner Neil E, Jewett Michael A, Zlotta Alexandre R, Trachtenberg John
Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Canada.
Urol Ann. 2010 May;2(2):58-62. doi: 10.4103/0974-7796.65107.
Since the introduction of nerve-sparing radical prostatectomy (NSRP), there have been concerns about the increased risks of positive surgical margins (PSM) and biochemical progression (BP). We examined the relationship of NSRP with PSM and BP using a large, mature dataset.
Patients who underwent RP for clinically localized prostate cancer at our center between 1997 and 2008 were identified. Patients who received neoadjuvant therapy were excluded. We examined the relation of NSRP to the rate of PSM and BP in univariate and multivariate analyses adjusting for clinical and pathological variables including age, pretreatment prostate-specific antigen (PSA) levels and doubling time, and pathological stage and grade.
In total, 856 patients were included, 70.9% underwent NSRP and 29.1% had non-NSRP. PSM rates were 13.5% in the NSRP group compared to 17.7% in non-NSRP (P=0.11). In a multivariate analysis, non-NSRP was preformed in patients with a higher pathological stage (HR 1.95, 95% CI 1.25-3.04, P=0.003) and a higher baseline PSA level (HR 1.04, 95% CI 1.01-1.08, P=0.005). With a median follow-up of 41 months, BP-free survival was 88% for non-NSRP compared to 92% for the NSRP group (log rank P=0.018); this difference was not significant in a multivariate Cox regression analysis (HR 0.54, 95% CI 0.28-1.06, P=0.09).
When used in properly selected patients, NSRP does not seem to increase the risk of PSM and disease progression. The most effective way of resolving this issue is through a randomized clinical trial; however, such a trial is not feasible.
自引入保留神经的根治性前列腺切除术（NSRP）以来，人们一直担心手术切缘阳性（PSM）和生化进展（BP）风险增加。我们使用一个大型、成熟的数据集研究了NSRP与PSM和BP之间的关系。
确定1997年至2008年期间在我们中心接受根治性前列腺切除术治疗临床局限性前列腺癌的患者。排除接受新辅助治疗的患者。我们在单变量和多变量分析中研究了NSRP与PSM率和BP的关系，并对包括年龄、治疗前前列腺特异性抗原（PSA）水平和倍增时间以及病理分期和分级在内的临床和病理变量进行了调整。
总共纳入856例患者，70.9%接受了NSRP，29.1%接受了非NSRP。NSRP组的PSM率为13.5%，而非NSRP组为17.7%（P = 0.11）。在多变量分析中，病理分期较高（HR 1.95，95%CI 1.25 - 3.04，P = 0.003）和基线PSA水平较高（HR 1.04，95%CI 1.01 - 1.08，P = 0.005）的患者接受了非NSRP。中位随访41个月，非NSRP组的无BP生存率为88%，而NSRP组为92%（对数秩检验P = 0.018）；在多变量Cox回归分析中，这种差异不显著（HR 0.54，95%CI 0.28 - 1.06，P = 0.09）。
在适当选择的患者中使用时，NSRP似乎不会增加PSM和疾病进展的风险。解决这个问题的最有效方法是通过随机临床试验；然而，这样的试验不可行。
