Tefilli M V, Gheiler E L, Tiguert R, Banerjee M, Sakr W, Grignon D J, Pontes J E, Wood D P
Department of Urology, Wayne State University School of Medicine and Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA.
J Urol. 1998 Sep;160(3 Pt 1):802-6. doi: 10.1016/S0022-5347(01)62791-5.
We identify prognostic factors in patients with seminal vesicle involvement and negative lymph nodes following radical prostatectomy for clinically localized prostate cancer.
A total of 93 patients who underwent radical prostatectomy and had seminal vesicle invasion without lymph node metastasis were evaluated. Patients who underwent neoadjuvant/adjuvant hormonal or radiation therapy were excluded from study. Preoperative serum prostate specific antigen (PSA), biopsy and radical prostatectomy specimen Gleason score, surgical margin status, presence of extraprostatic extension and evidence of biochemical disease progression were determined prospectively. Biochemical failure was defined as a single serum PSA elevation greater than 0.4 ng./ml.
The presence of positive surgical margins (p = 0.001), and Gleason score 7 or higher from preoperative biopsies (p = 0.03) and from the radical prostatectomy specimen (p = 0.01) were significant predictors of disease progression at a median followup of 43.3 months. Patients with preoperative PSA less than 10 ng./ml. had a better disease-free survival (p = 0.07). On multivariate analysis, after adjusting for biopsy Gleason score, prostatectomy Gleason score and serum PSA, positive surgical margins remained a statistically significant predictor of disease progression (p = 0.002).
Surgical margin status is an independent predictor of disease recurrence in patients with seminal vesicle involvement and negative lymph nodes following radical prostatectomy. Serum PSA 10 ng./ml. or greater and specimen Gleason score 7 or greater also were adverse prognostic factors in these patients. Conversely, patients with negative surgical margins and lymph nodes have a better prognosis than previously expected, despite seminal vesicle invasion.
我们确定临床局限性前列腺癌根治性前列腺切除术后精囊受累且淋巴结阴性患者的预后因素。
共评估了93例行根治性前列腺切除术且有精囊侵犯但无淋巴结转移的患者。接受新辅助/辅助激素或放射治疗的患者被排除在研究之外。前瞻性地确定术前血清前列腺特异性抗原（PSA）、活检及根治性前列腺切除标本的Gleason评分、手术切缘状态、前列腺外侵犯情况及生化疾病进展证据。生化失败定义为单次血清PSA升高大于0.4 ng/ml。
手术切缘阳性（p = 0.001），术前活检Gleason评分为7分或更高（p = 0.03）以及根治性前列腺切除标本Gleason评分为7分或更高（p = 0.01）是疾病进展的显著预测因素，中位随访时间为43.3个月。术前PSA小于10 ng/ml的患者无病生存率更好（p = 0.07）。多因素分析显示，在调整活检Gleason评分、前列腺切除Gleason评分和血清PSA后，手术切缘阳性仍是疾病进展的统计学显著预测因素（p = 0.002）。
手术切缘状态是根治性前列腺切除术后精囊受累且淋巴结阴性患者疾病复发的独立预测因素。血清PSA 10 ng/ml或更高以及标本Gleason评分为7分或更高也是这些患者的不良预后因素。相反，尽管有精囊侵犯，但手术切缘和淋巴结阴性的患者预后比先前预期的要好。
