Bosch R J, Kurth K H, Schroeder F H
Department of Urology, Erasmus University Rotterdam, The Netherlands.
J Urol. 1987 Oct;138(4):816-22. doi: 10.1016/s0022-5347(17)43383-0.
The fate of 48 patients with clinical stage T3 prostatic carcinoma after attempted curative surgical management was studied. In 23 of these patients positive frozen sections of the lymph nodes were found at pelvic lymphadenectomy and orchiectomy was performed. The median interval to progression was 61 months. Radical prostatectomy was performed in the remaining 25 patients. In 4 of these patients positive lymph nodes were found on paraffin sections but no additional treatment was given. Over-all, total tumor removal as defined by negative lymph nodes and negative margins of resection could be achieved in 14 of the 48 patients (29 per cent). During the same period 34 patients with clinical state T less than 3 prostatic carcinoma were treated in a similar manner. Orchiectomy was done in 4 patients because of positive frozen sections of the lymph nodes and radical prostatectomy was done in 30, including 1 in whom positive paraffin sections of the lymph nodes were found but no additional treatment was given. An attempt was made to study the impact of several prognostic factors by comparing the probability of progression between patients with stage pT3 disease with (T3pT3N0) or without (T less than 3pT3N0) extracapsular tumor growth as determined by preoperative rectal examination (36 versus 27 per cent progression at 3 years), with or without positive margins of resection (45 versus 20 per cent progression at 3 years) and with or without involvement of the seminal vesicles (47 versus 18 per cent progression at 3 years). Our results suggest that a certain proportion of patients with clinical stage T3 disease will benefit from radical prostatectomy. This is to be expected especially in patients with stage T3pT3N0 cancer and negative margins.
对48例临床分期为T3期前列腺癌患者进行根治性手术治疗后的转归进行了研究。其中23例患者在盆腔淋巴结清扫术时发现淋巴结冰冻切片阳性，遂行睾丸切除术。进展的中位间隔时间为61个月。其余25例患者行根治性前列腺切除术。其中4例患者石蜡切片发现淋巴结阳性，但未给予额外治疗。总体而言，48例患者中有14例（29%）实现了由阴性淋巴结和阴性切缘所定义的肿瘤完全切除。同期，对34例临床分期T小于3期的前列腺癌患者进行了类似治疗。4例患者因淋巴结冰冻切片阳性行睾丸切除术，30例行根治性前列腺切除术，其中1例石蜡切片发现淋巴结阳性，但未给予额外治疗。试图通过比较pT3期患者中术前直肠指检确定有（T3pT3N0）或无（T小于3pT3N0）包膜外肿瘤生长（3年进展率分别为36%和27%）、有或无切缘阳性（3年进展率分别为45%和20%）以及有或无精囊受累（3年进展率分别为47%和18%）的患者之间的进展概率，来研究几个预后因素的影响。我们的结果表明，一定比例的临床分期T3期疾病患者将从根治性前列腺切除术中获益。尤其在T3pT3N0期癌症且切缘阴性的患者中更是如此。
