摘要
目的 分析腹腔镜下根治性前列腺切除术后切缘阳性的影响因素.方法 回顾性分析2018年6月-2022年5月于青岛大学附属医院泌尿外科接受了腹腔镜下根治性前列腺切除术的238例前列腺癌患者的临床资料.根据术后病理检查结果,将纳入的患者分为切缘阳性组与切缘阴性组,比较两组患者的一般临床资料[年龄、体质量指数(BMI)、前列腺体积、手术方式]、术前血清总前列腺特异性抗原(TPSA)衍生指标[TPSA、游离前列腺特异性抗原(FPSA)/TPSA、前列腺特异性抗原密度(PSAD)]、穿刺因素(术前穿刺阳性针数比、术前穿刺Glea-son评分)、术前MRI影像学特征[术前临床分期、前列腺影像报告和数据系统(PI-RADS)评分、mpMRI肿瘤异常信号位置、mpMRI肿瘤异常信号部位、mpMRI膜部尿道长度、mpMRI最大肿瘤异常信号横径],通过多因素逻辑回归法分析前列腺癌术后切缘阳性率的影响因素.结果 两组患者的血清TPSA、血清PSAD、术前穿刺Gleason评分、术前穿刺阳性针数比、术前临床分期、mpMRI肿瘤异常信号位置比较差异均有显著性(x2=22.539～62.367,P＜0.05).多因素分析表明,术前临床分期(OR=3.574,95％CI=1.975～9.298,P＜0.05)、术前穿刺阳性针数比(OR=5.043,95％CI=2.496～10.189,P＜0.05)是切缘阳性的独立影响因素.结论 术前临床分期和术前穿刺阳性针数比是前列腺癌患者术后切缘阳性的独立影响因素,本研究为临床医生术前通过mpMRI的影像学特征预测患者术后切缘阳性提供了参考依据.
Abstract
Objective To investigate the predictive factors for positive surgical margin after laparoscopic radical prosta-tectomy.Methods A retrospective analysis was performed for the clinical data of 238 patients with prostate cancer who received laparoscopic radical prostatectomy in Department of Urinary Surgery,The Affiliated Hospital of Qingdao University from June 2018 to May 2022,and they were divided into negative margin group and positive margin group according to postoperative patholo-gy.Related data of two groups were compared,including general clinical data(age,body mass index,prostate volume,and surgi-cal procedure),preoperative serum total prostate-specific antigen(TPSA),related indices[TPSA,free prostate-specific antigen/TPSA ratio,and prostate-specific antigen density(PSAD)],puncture-related factors(percentage of positive biopsy cores and pre-operative puncture Gleason score),and preoperative MRI radiological features(preoperative clinical stage,prostate imaging report and Prostate Imaging Reporting and Data System score,location of abnormal tumor signal on mpMRI,site of abnormal tumor sig-nal on mpMRI,membranous urethra length on mpMRI,and maximum transverse diameter of abnormal tumor signal on mpMRI),and the influencing factors for positive margin after laparoscopic radical prostatectomy were analyzed.Results There were sig-nificant differences between the two groups in serum TPSA,serum PSAD,preoperative puncture Gleason score,preoperative per-centage of positive biopsy cores,preoperative clinical stage,and location of abnormal signal on mpMRI(x2=22.539-62.367,P＜0.05).The multivariate analysis showed that preoperative clinical stage(OR=3.574,95％CI=1.975-9.298,P＜0.05)and preo-perative percentage of positive biopsy cores(OR=5.043,95％CI=2.496-10.189,P＜0.05)were independent influencing factors for positive margin.Conclusion Preoperative clinical stage and preoperative percentage of positive biopsy cores are independent influencing factors for positive margin after laparoscopic radical prostatectomy,and this study provides a reference for predicting positive margin based on mpMRI radiological features among clinicians.
国家科技期刊平台
NSTL
维普
万方数据