van den Ouden D, Hop W C, Kranse R, Schröder F H
Department of Urology, Erasmus University and Academic Hospital, Rotterdam, The Netherlands.
Br J Urol. 1997 Feb;79(2):203-11. doi: 10.1046/j.1464-410x.1997.33011.x.
To evaluate the diagnosis, outcome and final pathology of radical prostatectomy for prostate cancer performed by urologists in a clinic where six urologists perform a total of 50 radical prostatectomies a year, using radical prostatectomy specimens processed routinely.
Radical prostatectomy was performed in 273 patients who were followed prospectively. The radical prostatectomy specimens were evaluated for pathological stage, histological grade, capsular perforation, positive and apical margins of resection, seminal vesicle invasion, perineural invasion and vascular invasion; the lymph node status was also determined. The relationship between these variables and clinical progression, local recurrence, distant metastases, biochemical progression, overall survival and cancer-specific survival was assessed.
All evaluated variables were significantly predictive for clinical and biochemical progression in the univariate analyses, and all but perineural invasion and lymph node status for cancer-specific survival. Multivariate analysis showed vascular invasion to be the most important prognostic variable, followed by capsular perforation, positive margins of resection and poorly differentiated carcinoma. The overall results for the evaluated variables were comparable to the results from centres with greater experience.
The outcome of treatment in this small clinic was similar to that from larger clinics with more experience. The routine evaluation of the radical prostatectomy specimens identified pathological variables which were important prognostic factors, with vascular invasion, capsular perforation, positive margins of resection and poorly differentiated carcinoma being the most significant. The extent of vascular invasion should be part of the routine evaluation of radical prostatectomy specimens.
评估在一家诊所中，由泌尿外科医生进行的前列腺癌根治性前列腺切除术的诊断、结果及最终病理情况。在该诊所，六位泌尿外科医生每年共进行50例根治性前列腺切除术，使用常规处理的根治性前列腺切除标本。
对273例行根治性前列腺切除术的患者进行前瞻性随访。评估根治性前列腺切除标本的病理分期、组织学分级、包膜穿孔、切除边缘阳性及尖部情况、精囊侵犯、神经周围侵犯和血管侵犯；同时确定淋巴结状态。评估这些变量与临床进展、局部复发、远处转移、生化进展、总生存及癌症特异性生存之间的关系。
在单因素分析中，所有评估变量均对临床和生化进展有显著预测作用，除神经周围侵犯和淋巴结状态外，所有变量对癌症特异性生存均有显著预测作用。多因素分析显示血管侵犯是最重要的预后变量，其次是包膜穿孔、切除边缘阳性和低分化癌。评估变量的总体结果与经验更丰富的中心的结果相当。
这家小诊所的治疗结果与经验更丰富的大诊所相似。对根治性前列腺切除标本的常规评估确定了作为重要预后因素的病理变量，其中血管侵犯、包膜穿孔、切除边缘阳性和低分化癌最为显著。血管侵犯的程度应作为根治性前列腺切除标本常规评估的一部分。
