■手术切缘阳性(PSM)不仅是复发的独立危险因素,转移,和预后,也是前列腺癌(PCa)患者行根治性前列腺切除术(RP)辅助治疗的重要指标。目前,很少有报道分析腹腔镜RP(LRP)中PSM的危险因素,尤其是那些接受新辅助激素治疗(NHT)的PCa病例。因此,本研究的目的是探讨有或无NHT的PCa患者LRP后发生PSM的危险因素.
■回顾性分析2012年1月至2020年7月行LRP患者的临床病理资料。分别探讨NHT组和非NHT组LRP后发生PSM的危险因素。
■总体PSM率为33.3%(90/270),非NHT患者的PSM率为39.3%(64/163),非NHT患者的PSM率为24.3%(26/107)。在非NHT组中,PSM的顶点是最常见的位置(68.8%,44/64),而眼底是NHT组PSM最常见的位置(57.7%,15/26)。多元logistic回归分析显示,体重指数(BMI)、PSA,LRP后的ISUP等级,病理分期T(pT)和病理淋巴结状态(pN)是影响非NHT患者PSM的独立因素(OR=1.160,95CI:1.034-1.301,p=0.011;OR=3.385,95CI:1.386-8.268,p=0.007;OR=3.541,95CI:1.008-12.444,p=0.049;OR=4.577,953124,p=2.6而pT,pN,和淋巴管浸润(LVI)是影响NHT患者PSM的独立危险因素(OR=18.434,95CI:4.976-68.297,p<0.001;OR=7.181,95CI:2.089-24.689,p=0.002;OR=3.545,95CI:1.109-11.327,p=0.033)。
■顶点是NHT组中最常见的位置,BMI,PSA,LRP后的ISUP,pT和pN是影响NHT患者PSM的独立危险因素;而眼底是非NHT组最常见的位置,和pT,pN,LVI是影响非NHT患者PSM的独立危险因素。
Positive surgical margins (PSM) is not only an independent risk factor for recurrence, metastasis, and prognosis, but also an important indicator of adjuvant therapy for prostate cancer (PCa) patients treated with radical prostatectomy (RP). At present, there are few reports analyzing risk factors of PSM in laparoscopic RP (LRP), especially for those PCa cases who accepted neoadjuvant hormonal therapy (NHT). Hence, the aim of the current study was to explore risk factors for PSM after LRP in PCa patients with and without NHT.
The clinicopathological data of patients who underwent LRP from January 2012 to July 2020 was retrospectively analyzed. Risk factors for PSM after LRP in NHT and non-NHT groups were respectively explored.
The overall PSM rate was 33.3% (90/270), PSM rate was 39.3% (64/163) in patients without NHT and 24.3% (26/107) in those with NHT. The apex was the most common location of PSM in non-NHT group (68.8%, 44/64), while the fundus was the most common location of PSM in NHT group (57.7%, 15/26). Multiple logistic regression revealed that body mass index (BMI), PSA, ISUP grade after LRP, pathological stage T (pT) and pathological lymph node status (pN) were independent factors affecting the PSM for patients without NHT (OR=1.160, 95%CI:1.034-1.301, p=0.011; OR=3.385, 95%CI:1.386-8.268, p=0.007; OR=3.541, 95%CI:1.008-12.444, p=0.049; OR=4.577, 95%CI:2.163-9.686, p<0.001; OR=3.572, 95%CI:1.124-11.347, p=0.031), while pT, pN, and lymphovascular invasion (LVI) were independent risk factors affecting PSM for patients with NHT (OR=18.434, 95%CI:4.976-68.297, p<0.001; OR=7.181, 95%CI:2.089-24.689, p=0.002; OR=3.545, 95%CI:1.109-11.327, p=0.033).
The apex was the most common location in NHT group, and BMI, PSA, ISUP after LRP, pT and pN were independent risk factors affecting PSM for NHT patients; while the fundus was the most common location in non-NHT group, and pT, pN, and LVI were independent risk factors affecting PSM for non-NHT patients.