前列腺癌根治性前列腺切除术后将尖端和膀胱颈部的软组织切缘由肿瘤阳性转为阴性对肿瘤学结果的影响。

The impact on oncological outcomes after radical prostatectomy for prostate cancer of converting soft tissue margins at the apex and bladder neck from tumour-positive to -negative.

机构信息

Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

出版信息

BJU Int. 2019 May;123(5):811-817. doi: 10.1111/bju.14480. Epub 2018 Jul 26.

DOI:10.1111/bju.14480

PMID:29978558

Abstract

OBJECTIVES

To assess the impact of conversion from histologically positive to negative soft tissue margins at the apex and bladder neck on biochemical recurrence-free survival (BCRFS) and distant metastasis-free survival (DMFS) after radical prostatectomy (RP) for prostate cancer.

MATERIALS AND METHODS

The records of 2 013 patients who underwent RP and intra-operative frozen section (IFS) analysis between July 2007 and June 2016 were reviewed. IFS analysis of the urethra and bladder neck was performed, and if malignant or atypical cells remained, further resection with the aim of achieving histological negativity was carried out. Patients were divided into three groups according to the findings: those with a negative surgical margin (NSM), a positive surgical margin converted to negative (NCSM) and a persistent positive surgical margin (PSM).

RESULTS

Among the 2 013 patients, rates of NSMs, NCSMs and PSMs were 75.1%, 4.9%, and 20.0%, respectively. The 5-year BCRFS rates of patients with NSMs, NCSMs and PSMs were 89.6%, 85.1% and 57.1%, respectively (P < 0.001). In both pathological (p)T2 and pT3 cancers, the 5-year BCRFS rate for patients with NCSMs was similar to that for patients with NSMs, and higher than for patients with PSMs. The 7-year DMFS rates of patients with NSMs, NCSMs and PSMs were 97.8%, 99.1% and 89.4%, respectively (P < 0.001). Among patients with pT3 cancers, the 7-year DMFS rate was significantly higher in the NCSM group than in the PSM group (98.0% vs 86.7%; P = 0.023), but not among those with pT2 cancers (100% vs 96.9%; P = 0.616). The 5-year BCRFS rate for the NCSM group was not significantly different from that of the NSM group among the patients with low- (96.3% vs 95.8%) and intermediate-risk disease (91.1% vs 82.8%), but was lower than that of the NSM group among patients in the high-risk group (73.2% vs 54.7%).

CONCLUSIONS

Conversion of the soft tissue margin at the prostate apex and bladder neck from histologically positive to negative improved the BCRFS and DMFS after RP for prostate cancer; however, the benefit of conversion was not apparent in patients in the high-risk group.

摘要

目的

评估前列腺癌根治性前列腺切除术后（RP）由组织学阳性转为阴性的尖部和膀胱颈软组织切缘对生化无复发生存（BCRFS）和远处无转移生存（DMFS）的影响。

材料与方法

回顾分析 2007 年 7 月至 2016 年 6 月期间接受 RP 和术中冰冻切片（IFS）分析的 2013 例患者的记录。对尿道和膀胱颈进行 IFS 分析，如果仍有恶性或非典型细胞存在，则进一步切除以达到组织学阴性。根据研究结果将患者分为三组：阴性手术切缘（NSM）、阳性手术切缘转为阴性（NCSM）和持续阳性手术切缘（PSM）。

结果

在 2013 例患者中，NSM、NCSM 和 PSM 的比例分别为 75.1%、4.9%和 20.0%。NSM、NCSM 和 PSM 患者的 5 年 BCRFS 率分别为 89.6%、85.1%和 57.1%（P < 0.001）。在病理（p）T2 和 pT3 癌症中，NCSM 患者的 5 年 BCRFS 率与 NSM 患者相似，高于 PSM 患者。NSM、NCSM 和 PSM 患者的 7 年 DMFS 率分别为 97.8%、99.1%和 89.4%（P < 0.001）。在 pT3 癌症患者中，NCSM 组的 7 年 DMFS 率显著高于 PSM 组（98.0%比 86.7%；P = 0.023），但在 pT2 癌症患者中则无显著差异（100%比 96.9%；P = 0.616）。在低危（96.3%比 95.8%）和中危（91.1%比 82.8%）疾病患者中，NCSM 组的 5 年 BCRFS 率与 NSM 组无显著差异，但在高危组患者中，NCSM 组的 5 年 BCRFS 率低于 NSM 组（73.2%比 54.7%）。