Liu Fu-Chao, Hua Kuo-Chun, Lin Jr-Rung, Pang See-Tong, Yu Huang-Ping
The Department of Anesthesiology, Chang Gung Memorial Hospital.
College of Medicine.
Medicine (Baltimore). 2019 Jan;98(3):e13897. doi: 10.1097/MD.0000000000013897.
To analyze whether different volumes of tissue resected during transurethral resection of the prostate (TURP) would associate with the subsequent development of prostate cancer.This population-based retrospective cohort study recruited 49,206 patients with benign prostate hyperplasia (BPH) undergoing TURP between 2005 and 2012. Patients were recruited from the Taiwan National Health Insurance Research Database. Patients were separated into three groups, based on different volumes of tissue resected during TURP (5-15 g, 15-50 g, >50 g).Of the 49,206 patients, 633 patients were diagnosed with new onset of prostate cancer following TURP. Older age was a risk factor contributing to the onset of prostate cancer (P = .0196) and different volumes of tissue resected were significantly related to the incidence of postoperative prostate cancer (P = .0399). The group of patients with a smaller volume of prostate resected had a higher risk of prostate cancer with a hazard ratio (HR) of 1.221 (95% confidence interval [CI]: 1.035, 1.440; P = .0179). However, the risk in the group of patients with a larger volume of prostrate resected was not significantly different, with an HR of 1.277 (95% CI: 0.981, 1662; P = .0690). The incidence of prostate cancer in Taiwanese males over 30 years of age has previously been reported to be 0.0560%; the mean incidence was 0.2282% in our present study.This study shows that BPH patients who had a smaller volume of tissue resected during TURP show a higher incidence of prostate cancer postoperatively. Currently, no clear mechanism is shown to demonstrate the relationship between resected prostate weight and the incidence of tumors. Patients with a larger prostate volume might have lower urinary tract symptoms earlier and then seek professional help. It is possible that surgical procedures might remove the potentially carcinogenic prostate tissue and thus reduce the risk of an aggressive tumor developing in the future.
分析经尿道前列腺电切术（TURP）期间切除的不同组织体积是否与随后前列腺癌的发生有关。这项基于人群的回顾性队列研究招募了2005年至2012年间49206例接受TURP的良性前列腺增生（BPH）患者。患者来自台湾国民健康保险研究数据库。根据TURP期间切除的不同组织体积（5 - 15克、15 - 50克、>50克）将患者分为三组。在49206例患者中，633例患者在TURP后被诊断为新发前列腺癌。年龄较大是前列腺癌发病的一个危险因素（P = 0.0196），切除的不同组织体积与术后前列腺癌的发病率显著相关（P = 0.0399）。切除前列腺体积较小的患者组患前列腺癌的风险较高，风险比（HR）为1.221（95%置信区间[CI]：1.035，1.440；P = 0.0179）。然而，切除前列腺体积较大的患者组的风险没有显著差异，HR为1.277（95% CI：0.981，1.662；P = 0.0690）。此前报道台湾30岁以上男性前列腺癌的发病率为0.0560%；在我们目前的研究中，平均发病率为0.2282%。本研究表明，TURP期间切除组织体积较小的BPH患者术后前列腺癌的发病率较高。目前，尚无明确机制表明切除的前列腺重量与肿瘤发病率之间的关系。前列腺体积较大的患者可能更早出现下尿路症状，然后寻求专业帮助。有可能手术操作可能切除了潜在致癌的前列腺组织，从而降低了未来发生侵袭性肿瘤的风险。
