Lee Hye Won, Jeon Hwang Gyun, Jeong Byong Chang, Seo Seong Il, Jeon Seong Soo, Lee Hyun Moo, Choi Han Yong
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ; Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Med Sci. 2015 Nov;30(11):1631-7. doi: 10.3346/jkms.2015.30.11.1631. Epub 2015 Oct 16.
The aim of this study was to investigate a single-institution experience with radical perineal prostatectomy (RPP), radical retropubic prostatectomy (RRP) and minimally invasive radical prostatectomy (MIRP) with respect to onco-surgical outcomes in patients with intermediate-risk (IR; PSA 10-20 ng/mL, biopsy Gleason score bGS 7 or cT2b-2c) and high-risk (HR; PSA > 20 ng/mL, bGS ≥ 8, or ≥ cT3) prostate cancer (PCa). We retrospectively reviewed data from 2,581 men who underwent radical prostatectomy for IR and HR PCa (RPP, n = 689; RRP, n = 402; MIRP, n = 1,490 [laparoscopic, n = 206; robot-assisted laparoscopic, n = 1,284]). The proportion of HR PCa was 40.3%, 46.8%, and 49.5% in RPP, RRP, and MIRP (P < 0.001), respectively. The positive surgical margin rate was 23.8%, 26.1%, and 18.7% (P = 0.002) overall, 17.5%, 17.8%, and 8.8% (P < 0.001) for pT2 disease and 41.9%, 44.4%, and 40.0% (P = 0.55) for pT3 disease in men undergoing RPP, RRP, and MIRP, respectively. Biochemical recurrence-free survival rates among RPP, RRP, and MIRP were 73.0%, 70.1%, and 76.8%, respectively, at 5 yr (RPP vs. RPP, P = 0.02; RPP vs. MIRP, P = 0.23). Furthermore, comparable 5-yr metastases-free survival rates were demonstrated for specific surgical approaches (RPP vs. RPP, P = 0.26; RPP vs. MIRP, P = 0.06). RPP achieved acceptable oncological control for IR and HR PCa.
本研究旨在探讨在单机构中，针对中危（IR；前列腺特异性抗原[PSA] 10 - 20 ng/mL，活检Gleason评分bGS 7或临床分期cT2b - 2c）和高危（HR；PSA > 20 ng/mL，bGS≥8，或≥cT3）前列腺癌（PCa）患者，行根治性会阴前列腺切除术（RPP）、根治性耻骨后前列腺切除术（RRP）和微创根治性前列腺切除术（MIRP）后的肿瘤外科治疗效果。我们回顾性分析了2581例因IR和HR PCa接受根治性前列腺切除术患者的数据（RPP，n = 689；RRP，n = 402；MIRP，n = 1490 [腹腔镜手术，n = 206；机器人辅助腹腔镜手术，n = 1284]）。RPP、RRP和MIRP中HR PCa的比例分别为40.3%、46.8%和49.5%（P < 0.001）。总体切缘阳性率分别为23.8%、26.1%和18.7%（P = 0.002）；对于pT2期疾病，行RPP、RRP和MIRP的患者切缘阳性率分别为17.5%、17.8%和8.8%（P < 0.001）；对于pT3期疾病，分别为41.9%、44.4%和40.0%（P = 0.55）。RPP、RRP和MIRP的5年无生化复发生存率分别为73.0%、70.1%和76.8%（RPP与RRP比较，P = 0.02；RPP与MIRP比较，P = 0.23）。此外，特定手术方式的5年无转移生存率相当（RPP与RRP比较，P = 0.26；RPP与MIRP比较，P = 0.06）。RPP对IR和HR PCa实现了可接受的肿瘤学控制。
