术前 PSA 值<4ng/ml 的患者接受机器人辅助根治性前列腺切除术的手术和肿瘤学结果。
Surgical and oncological outcomes in patients with a preoperative PSA value <4 ng/ml undergoing robot-assisted radical prostatectomy.
机构信息
Department of Urology and Pediatric Urology, St. Antonius Medical Center, Moellenweg 22, 48599 Gronau, Germany.
出版信息
Anticancer Res. 2012 May;32(5):2079-83.
BACKGROUND
The objective of this study was to assess the surgical and oncological outcomes in patients with a preoperative prostate specific antigen (PSA) value <4 ng/ml undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer.
PATIENTS AND METHODS
The records of 2000 men who underwent RARP from February 2006 to April 2010, were retrospectively reviewed. A total of 169 (8.4%) patients with a preoperative PSA value <4 ng/ml were identified. A comparison was performed between the overall patient cohort and the aforementioned patients. The analyzed parameters included: minor and major postoperative complications, postoperative Gleason score, pathological stage, positive margin status as well as presence of biochemical progression and of disease-specific mortality during the follow-up period.
RESULTS
The following results reflect the comparison of the overall cohort of patients vs. the cohort of patients who had a preoperative PSA value <4 ng/ml. A statistical difference of the analyzed parameters was observed in the median PSA value; 10.3 ng/ml (0.3-220 ng/ml) vs. 2.8 ng/ml (0.3-3.9 ng/ml) (p<0.001), in bilateral NVB; 65.7% vs. 85.2% (p<0.001), in Gleason score <7; 42.8% vs. 59.1% (p<0.05), in Gleason score 7; 47.7% vs. 36.6% (p<0.05) and in Gleason score >7 in 9.5% vs. 3.5% (p<0.001). Organ-confined disease was noted in 73.5% vs. 86.3% (p<0.05), extraprostatic extension in 25.2% vs. 13.7% (p<0.05). The percentage of cancer found in the prostate specimen was 16.1% (1-99%) vs. 7.3% (1-96%) (p<0.05) and a positive surgical margin status was encountered in 8.9% vs. 4.7% (p<0.05) of patients. Pelvic lymph node dissection was performed in 1623 patients (81.2%) of the overall cohort out of whom 64 cases (3.2%) were positive for metastasis. In the patient cohort of PSA value <4 ng/ml, pelvic lymph node dissection was performed in 114 patients (67.4%), out of which one case (0.5%) was positive for metastasis (p<0.05). After a median follow-up of 24.2 months (range 3-56 months), 162 patients (95.8%) were free of biochemical progression and no disease-specific mortality was evident.
CONCLUSION
RARP in patients with a preoperative PSA value <4 ng/ml is a safe surgical procedure with limited complications and excellent oncological outcome.
背景
本研究旨在评估术前前列腺特异抗原（PSA）值<4ng/ml 的患者接受机器人辅助根治性前列腺切除术（RARP）治疗前列腺癌的手术和肿瘤学结果。
患者和方法
回顾性分析了 2006 年 2 月至 2010 年 4 月期间接受 RARP 的 2000 名男性患者的记录。共确定了 169 名（8.4%）术前 PSA 值<4ng/ml 的患者。对总体患者队列和上述患者进行了比较。分析的参数包括：术后轻微和严重并发症、术后 Gleason 评分、病理分期、阳性切缘状态以及在随访期间是否存在生化进展和疾病特异性死亡率。
结果
以下结果反映了总体患者队列与术前 PSA 值<4ng/ml 的患者队列的比较。分析参数的中位数 PSA 值存在统计学差异；10.3ng/ml（0.3-220ng/ml）vs.2.8ng/ml（0.3-3.9ng/ml）（p<0.001），双侧 NVB 为 65.7% vs.85.2%（p<0.001），Gleason 评分<7 为 42.8% vs.59.1%（p<0.05），Gleason 评分 7 为 47.7% vs.36.6%（p<0.05），Gleason 评分>7 为 9.5% vs.3.5%（p<0.001）。73.5%的患者为器官局限性疾病，86.3%为局限性疾病（p<0.05），25.2%为外生型，13.7%为局限性疾病（p<0.05）。前列腺标本中发现的癌症百分比为 16.1%（1-99%）vs.7.3%（1-96%）（p<0.05），阳性切缘状态为 8.9% vs.4.7%（p<0.05）。总体队列中 1623 名患者（81.2%）接受了盆腔淋巴结清扫术，其中 64 例（3.2%）为阳性。在 PSA 值<4ng/ml 的患者队列中，114 名患者（67.4%）接受了盆腔淋巴结清扫术，其中 1 例（0.5%）为阳性（p<0.05）。中位随访 24.2 个月（3-56 个月）后，162 名患者（95.8%）无生化进展，无疾病特异性死亡。
结论
RARP 治疗术前 PSA 值<4ng/ml 的患者是一种安全的手术方法，并发症有限，肿瘤学结果良好。
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