Wang Jin-Guo, Huang Jiaoti, Chin Arnold I
Department of Urology, Institute of Urologic Oncology, Broad Stem Cell Research Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
Asian J Androl. 2014 Sep-Oct;16(5):715-9. doi: 10.4103/1008-682X.129942.
To examine the outcomes of patients with high-risk prostate cancer (PCa) treated by robot-assisted radical prostatectomy (RARP) and evaluate the value of multi-parametric magnetic resonance imaging (MRI) in estimating tumor stage, extracapsular extension, and grade, and the application of nerve sparing (NS) techniques. Patient demographics, preoperative imaging, surgical parameters, pathological features, functional and recurrence outcomes were collected retrospectively in patients with high-risk PCa who underwent RARP between December 2009 and October 2013. Pathological whole mount slides to assess NS were compared with potency, recovery of continence, and surgical margins (SM). Forty-four cases of high-risk PCa were identified with a median followup of 24 months and positive surgical margins (PSM) rate of 14%. Continence returned in 86%, with potency rate of 58%. Of the 25 cases with a preoperative multi-parametric MRI, MRI improved clinical staging from 28% to 88%, respectively. Following risk stratification of NS by microscopic analysis of whole mount pathology, patients with Group A (bilateral NS), Group B (unilateral NS), Group C (partial NS), and Group D (non-NS) had 100%, 92%, 91%, and 50% continence rates, and 100%, 80%, 45%, and 0% potency rates, respectively, with an inverse correlation to PSM. RARP in men with high-risk PCa can achieve favorable oncologic and functional outcomes. Preoperative MRI may localize high-grade tumors and improve clinical staging. Extent of NS is influenced by clinical staging and may balance potency and continence with PSMs.
为了研究接受机器人辅助根治性前列腺切除术（RARP）治疗的高危前列腺癌（PCa）患者的预后，并评估多参数磁共振成像（MRI）在估计肿瘤分期、包膜外侵犯及分级方面的价值，以及保留神经（NS）技术的应用。对2009年12月至2013年10月期间接受RARP的高危PCa患者的人口统计学资料、术前影像学检查、手术参数、病理特征、功能及复发情况进行回顾性收集。将用于评估NS的病理全层切片与性功能、控尿恢复情况及手术切缘（SM）进行比较。共确定44例高危PCa患者，中位随访时间为24个月，手术切缘阳性（PSM）率为14%。86%的患者恢复控尿，性功能恢复率为58%。在25例术前行多参数MRI检查的患者中，MRI将临床分期的准确率分别从28%提高至88%。通过对全层病理的显微镜分析对NS进行风险分层后，A组（双侧NS）、B组（单侧NS）、C组（部分NS）和D组（非NS）患者的控尿率分别为100%、92%、91%和50%，性功能恢复率分别为100%、80%、45%和0%，与PSM呈负相关。高危PCa男性患者接受RARP可获得良好的肿瘤学和功能预后。术前MRI可定位高级别肿瘤并改善临床分期。NS的范围受临床分期影响，可在性功能、控尿与PSM之间取得平衡。
