Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
Institute of Urology, Nanjing University, Nanjing, China.
BJU Int. 2020 Jul;126(1):152-158. doi: 10.1111/bju.15060. Epub 2020 Apr 17.
To investigate the influence of tumour location zone on positive surgical margin (PSM) status after Retzius-sparing robot-assisted radical prostatectomy (RS-RARP).
A total of 203 consecutive patients with prostate cancer (PCa) who underwent RS-RARP at our centre were divided into three cohorts according to the tumour zonal origin described on preoperative magnetic resonance imaging (MRI). Clinical and pathological characteristics were compared among the three groups. The associations of clinicopathological variables with PSM status after RS-RARP were also evaluated.
The rates of PSM in patients with transition zone (TZ) and mixed origin tumours were significantly higher than in patients with peripheral zone tumours (P < 0.01). Of the PSMs in patients with TZ and mixed origin cancers, 42.0% and 40.9%, respectively, were located at the anterior part of the gland. On multivariate analysis, presence of a TZ tumour was significantly associated with a higher PSM rate after RS-RARP (P < 0.01). Sub-analysis showed that high-risk patients with TZ tumours had a higher risk of PSM after RS-RARP (P < 0.01).
Presence of a TZ tumour is an independent risk factor for PSMs after RS-RARP. Preoperative identification of TZ tumours might aid surgical planning for the Retzius-sparing technique, especially in high-risk patients.
探讨保留耻骨后间隙的机器人辅助根治性前列腺切除术（RS-RARP）中肿瘤位置区对阳性切缘（PSM）状态的影响。
本研究共纳入 203 例在我中心接受 RS-RARP 的前列腺癌（PCa）患者，根据术前磁共振成像（MRI）描述的肿瘤区来源将其分为三组。比较三组间的临床病理特征。评估 RS-RARP 后与 PSM 状态相关的临床病理变量。
在 TZ 和混合起源肿瘤患者中 PSM 的发生率明显高于外周带肿瘤患者（P < 0.01）。在 TZ 和混合起源肿瘤患者的 PSM 中，分别有 42.0%和 40.9%位于腺体的前部分。多因素分析显示，TZ 肿瘤的存在与 RS-RARP 后 PSM 发生率较高显著相关（P < 0.01）。亚组分析显示，TZ 肿瘤的高危患者 RS-RARP 后 PSM 的风险更高（P < 0.01）。
TZ 肿瘤的存在是 RS-RARP 后 PSM 的独立危险因素。术前识别 TZ 肿瘤可能有助于保留耻骨后间隙技术的手术规划，尤其是在高危患者中。
