Catalona W J, Smith D S
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
J Urol. 1998 Dec;160(6 Pt 2):2428-34. doi: 10.1097/00005392-199812020-00012.
We evaluate cancer recurrence and survival rates following anatomic radical retropubic prostatectomy.
From 1983 through August 1997, 1 surgeon performed anatomic radical retropubic prostatectomy in 1,778 men (mean age plus or minus standard deviation 63+/-7), using a unilateral or bilateral nerve sparing modification when feasible (93%). Postoperative adjuvant radiation therapy (mean dose 60 Gy.) was given to 4% of patients because of adverse pathological findings. Patients were followed with semiannual prostate specific antigen (PSA) tests and annual digital rectal examinations. Followup PSA 0.3 ng./ml. or greater was considered evidence of cancer recurrence. We used Kaplan-Meier product limit estimates to calculate 7-year cancer recurrence-free probabilities, prostate cancer specific survival and all cause survival (overall, and stratified by age, preoperative PSA, tumor grade and tumor stage). We used multivariate Cox proportional hazards models to determine clinical and pathological parameters that provided unique predictive information about cancer recurrence.
The 7-year recurrence-free survival was significantly associated with lower preoperative PSA (estimated probability of nonprogression 76 to 93% for PSA less than 10), nonpalpable, localized clinical stage (79%), lower tumor grade (84 and 68% for well and moderately differentiated, respectively) and localized pathological stage (81% for pT1 or pT2) (all log rank test p <0.0001) but not age at surgery. All predictors except clinical stage and age remained significant within the multivariate model. Controlling for all other predictors, adjuvant radiation therapy in patients with unfavorable pathology was significantly associated with better recurrence-free survival (p=0.02). The estimated 7-year prostate cancer specific survival rate was 97% and the all cause survival rate was 90%. Cancer specific and all cause survival were significantly associated with lower grade and localized pathological stage (p <0.0001).
Anatomic radical retropubic prostatectomy with the nerve sparing modification can be performed with good cancer control.
我们评估耻骨后根治性前列腺切除术（保留神经的改良术式）后的癌症复发率和生存率。
1983年至1997年8月间，1名外科医生为1778例男性患者（平均年龄63±7岁）实施了耻骨后根治性前列腺切除术，可行时采用单侧或双侧保留神经改良术式（93%）。4%的患者因不良病理结果接受了术后辅助放疗（平均剂量60 Gy）。患者接受每半年一次的前列腺特异性抗原（PSA）检测和每年一次的直肠指检。随访时PSA≥0.3 ng/ml被视为癌症复发的证据。我们使用Kaplan-Meier乘积限估计法计算7年无癌复发概率、前列腺癌特异性生存率和全因生存率（总体，以及按年龄、术前PSA、肿瘤分级和肿瘤分期分层）。我们使用多变量Cox比例风险模型来确定能够提供有关癌症复发独特预测信息的临床和病理参数。
7年无癌复发生存率与术前PSA较低（PSA<10时无进展的估计概率为76%至93%）、不可触及的局限性临床分期（79%）、较低的肿瘤分级（高分化和中分化分别为84%和68%）以及局限性病理分期（pT1或pT2为81%）显著相关（所有对数秩检验p<0.0001），但与手术年龄无关。多变量模型中，除临床分期和年龄外，所有预测因素均保持显著。在控制所有其他预测因素后，病理结果不佳的患者接受辅助放疗与更好的无癌复发生存率显著相关（p=0.02）。估计7年前列腺癌特异性生存率为97%，全因生存率为90%。癌症特异性生存率和全因生存率与较低分级和局限性病理分期显著相关（p<0.0001）。
采用保留神经改良术式的耻骨后根治性前列腺切除术可实现良好的癌症控制。
