Urology Division, Azienda Ospedaliero-Universitaria delle Marche, School of Urology, Polytechnic University of the Marche Region, Ancona, Italy.
Section of Pathological Anatomy, Azienda Ospedaliero-Universitaria delle Marche, Marche Polytechnic University, Ancona, Italy.
Urol Oncol. 2023 Jun;41(6):293.e9-293.e14. doi: 10.1016/j.urolonc.2023.03.011. Epub 2023 May 2.
Prostate cancer with seminal vesicle invasion (SVI) has been considered an aggressive cancer. To evaluate the prognostic significance of different patterns of isolated SVI in patients undergoing radical prostatectomy (RP) and pelvic lymphadenectomy.
We retrospectively analyzed all patients who underwent RP between 2007 and 2019. Inclusion criteria were localized prostate adenocarcinoma, SVI at RP, at least 24-months follow-up, and no adjuvant treatment. Patterns of SVI were following Ohori's classification: type 1: direct spread along the ejaculatory duct from inside; type 2: seminal vesicle invasion outside the prostate, through the capsule; type 3: the presence of cancer island(s) in the seminal vesicle with no continuity from the primary tumor (discontinuous metastases). Patients with type 3 SVI (isolated or in association) were included in the same group. Biochemical recurrence (BCR) was defined as any postoperative PSA ≥0.2 ng/ml. A logistic regression analysis was performed to assess predictors of BCR. Time to BCR was investigated using the Kaplan-Meier analysis with the log-rank test.
Sixty-one out of 1,356 patients were included. Median age was 67(7.2) years. Median PSA was 9.4(8.92) ng/ml. Mean follow-up was 85.28 ± 45.27 months. BCR occurred in 28(45.9%) patients. Logistic regression showed that a positive surgical margin (OR 19.964, 95%CI:1.172-29.322, P = 0.038) was predictor of BCR. Kaplan-Meier analysis demonstrated that patients with pattern 3 had a significantly shorter time to BCR compared to other groups (log-rank, P = 0.016). The estimated time to BCR was 48.7 months in type 3, 60.9 months in pattern 1 + 2, 74.8, and 100.8 months in isolated patterns 1 and 2, respectively. In patients with negative surgical margins, pattern 3 confirmed a shorter time to BCR compared to other types of invasions, with an estimated time to BCR of 30.8 months.
Patients with type 3 SVI demonstrated a shorter time to BCR compared to other patterns.
前列腺癌伴精囊侵犯（SVI）被认为是一种侵袭性癌症。评估在接受根治性前列腺切除术（RP）和盆腔淋巴结清扫术的患者中，不同类型孤立性 SVI 的预后意义。
我们回顾性分析了 2007 年至 2019 年期间接受 RP 的所有患者。纳入标准为局限性前列腺腺癌、RP 时 SVI、至少 24 个月随访、无辅助治疗。SVI 模式遵循 Ohori 分类：1 型：直接沿射精管从内部扩散；2 型：前列腺外精囊侵犯，穿过包膜；3 型：精囊内存在癌岛，但与原发肿瘤无连续性（不连续转移）。将具有 3 型 SVI（孤立或并存）的患者归入同一组。生化复发（BCR）定义为任何术后 PSA≥0.2ng/ml。使用逻辑回归分析评估 BCR 的预测因素。使用 Kaplan-Meier 分析和对数秩检验评估 BCR 时间。
在 1356 名患者中有 61 名符合条件。中位年龄为 67（7.2）岁。中位 PSA 为 9.4（8.92）ng/ml。平均随访时间为 85.28±45.27 个月。28 名（45.9%）患者发生 BCR。逻辑回归显示，阳性切缘（OR 19.964，95%CI：1.172-29.322，P=0.038）是 BCR 的预测因素。Kaplan-Meier 分析表明，与其他组相比，模式 3 患者的 BCR 时间明显缩短（对数秩，P=0.016）。在模式 3 中，估计的 BCR 时间为 48.7 个月，在模式 1+2 中为 60.9 个月，在孤立模式 1 和 2 中分别为 74.8 和 100.8 个月。在阴性切缘患者中，与其他类型的侵犯相比，模式 3 证实 BCR 时间更短，估计 BCR 时间为 30.8 个月。
与其他类型相比，3 型 SVI 患者的 BCR 时间更短。
