Department of Urologic Surgery, First People's Hospital of Jiujiang, Jiujiang, Jiangxi 332000, China.
Chin Med J (Engl). 2012 May;125(9):1529-35.
Although many midterm oncologic data have been reported for extraperitoneal laparoscopic radical prostatectomy (ELRP) in western countries, few oncologic data of the extraperitoneal procedure was published in China. The aim of the study was to evaluate the oncologic outcomes of patients treated with ELRP in China.
From January 2005 to March 2010, a total of 152 consecutive patients diagnosed with clinically localized prostate cancer were included in this study and treated with ELRP. The patients were staged according to the TNM (tumor, nodes, metastases) system. Median and mean postoperative follow-up were 28.1 months and 27.0 months, respectively. The patients were retrospectively analyzed for progression-free survival.
One hundred and twelve cases (73.7%) were postoperatively diagnosed as pT2 in, and 40 cases (26.3%) as pT3. Positive lymph nodes were shown in 5 patients (3.3%). Gleason score was < 7 in 49 men (32.2%), 7 in 69 men (45.4%), and > 7 in 34 men (22.4%). Positive surgical margins (PSM) were observed in 15 patients (9.9%), which included 32.0% of all pT3a cases and 46.7% of all pT3b cases, respectively. The overall prostate-specific antigen recurrence-free survival rate was 86% in all patients. The recurrence-free survival rates were 91.8% and 62.2% in pT2N0 patients and pT3N0 patients, respectively. Preoperative prostate-specific antigen, surgical margins, tumor stage, and lymph nodal status were identified as independent predictors of biochemical recurrence-free survival using multivariate Cox proportional hazard model.
ELRP is a precise, safe and effective procedure at this particular Chinese institution. The prognostic power of prostate-specific antigen relapse after ELRP is not identical to that described previously with transperitoneal or open retropubic approaches.
尽管西方国家已经报道了许多关于腹膜外腹腔镜根治性前列腺切除术（ELRP）的中期肿瘤学数据，但在中国发表的关于该腹膜外手术的肿瘤学数据却很少。本研究旨在评估在中国接受 ELRP 治疗的患者的肿瘤学结果。
2005 年 1 月至 2010 年 3 月，共有 152 例临床局限性前列腺癌患者连续纳入本研究并接受 ELRP 治疗。患者根据 TNM（肿瘤、淋巴结、转移）系统分期。中位和平均术后随访时间分别为 28.1 个月和 27.0 个月。对无进展生存率进行回顾性分析。
112 例（73.7%）术后诊断为 pT2，40 例（26.3%）为 pT3。5 例（3.3%）患者有阳性淋巴结。49 例（32.2%）男性 Gleason 评分为<7，69 例（45.4%）为 7，34 例（22.4%）为>7。15 例（9.9%）患者出现阳性切缘（PSM），其中 pT3a 患者的阳性切缘率为 32.0%，pT3b 患者的阳性切缘率为 46.7%。所有患者的前列腺特异性抗原无复发生存率为 86%。pT2N0 患者和 pT3N0 患者的无复发生存率分别为 91.8%和 62.2%。多因素 Cox 比例风险模型显示，术前前列腺特异性抗原、手术切缘、肿瘤分期和淋巴结状态是生化无复发生存的独立预测因素。
在中国的特定机构，ELRP 是一种精确、安全和有效的手术。ELRP 后前列腺特异性抗原复发的预后能力与经腹腔或开放式耻骨后入路描述的情况不完全相同。
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