CAJ | 학술논문

目的：探讨前列腺穿刺活检提示神经周围侵犯（ perineural invasion in biopsy ，PNIb）对前列腺癌分期、进展的评估价值。方法回顾性分析2006年1月至2013年3月收治的316例前列腺癌患者的临床资料，年龄51～80岁，平均69岁。穿刺前平均血清PSA水平为15．7μg/L。所有患者术前均接受CT或MRI及核素骨扫描检查，未发现肿瘤局部浸润或远处转移。均行经直肠超声引导下前列腺穿刺活检，术前诊断为局限性前列腺癌。手术方式均采用腹腔镜下根治性前列腺切除术。比较有PNIb组与无PNIb组根治术后病理的Gleason评分、手术切缘阳性率、肿瘤包膜侵犯率及精囊侵犯率等指标的差异。比较PNIb与根治性术后病理结果中神经周围侵犯（ perineural invasion in prostatectomy specimen ，PNIp）分布情况的一致性。结果本组316例中， PNIb 发生率为32．5％（103/316）。有PNIb组与无PNIb组根治术后病理Gleason评分≤6分（16例与92例）、7分（46例与87例）、≥8分（41例与34例）间比较差异均有统计学意义（P＜0．05）；手术切缘阳性（75例与43例）、包膜侵犯（47例与36例）及精囊侵犯（32例与23例）间比较差异均有统计学意义（P＜0．05）。多因素Logistic回归分析结果显示PNIb可作为手术切缘阳性、包膜侵犯、精囊侵犯（ OR＝11．358、OR＝1．785、OR＝2．364，P＜0．05）发生的独立相关因素。本组103例PNIb中，22例为双侧PNIb，根治术后病理为双侧PNIp；81例为单侧PNIb，根治术后病理中55例为双侧PNIp，PNIb与PNIp发生部位比较差异有统计学意义（ P＜0．05）。结论 PNIb可以作为评估前列腺癌肿瘤进展及发生范围的有效指标。
목적：탐토전렬선천자활검제시신경주위침범（ perineural invasion in biopsy ，PNIb）대전렬선암분기、진전적평고개치。방법회고성분석2006년1월지2013년3월수치적316례전렬선암환자적림상자료，년령51～80세，평균69세。천자전평균혈청PSA수평위15．7μg/L。소유환자술전균접수CT혹MRI급핵소골소묘검사，미발현종류국부침윤혹원처전이。균행경직장초성인도하전렬선천자활검，술전진단위국한성전렬선암。수술방식균채용복강경하근치성전렬선절제술。비교유PNIb조여무PNIb조근치술후병리적Gleason평분、수술절연양성솔、종류포막침범솔급정낭침범솔등지표적차이。비교PNIb여근치성술후병리결과중신경주위침범（ perineural invasion in prostatectomy specimen ，PNIp）분포정황적일치성。결과본조316례중， PNIb 발생솔위32．5％（103/316）。유PNIb조여무PNIb조근치술후병리Gleason평분≤6분（16례여92례）、7분（46례여87례）、≥8분（41례여34례）간비교차이균유통계학의의（P＜0．05）；수술절연양성（75례여43례）、포막침범（47례여36례）급정낭침범（32례여23례）간비교차이균유통계학의의（P＜0．05）。다인소Logistic회귀분석결과현시PNIb가작위수술절연양성、포막침범、정낭침범（ OR＝11．358、OR＝1．785、OR＝2．364，P＜0．05）발생적독립상관인소。본조103례PNIb중，22례위쌍측PNIb，근치술후병리위쌍측PNIp；81례위단측PNIb，근치술후병리중55례위쌍측PNIp，PNIb여PNIp발생부위비교차이유통계학의의（ P＜0．05）。결론 PNIb가이작위평고전렬선암종류진전급발생범위적유효지표。
Objective To assess perineural invasion in prostate needle biopsy ( PNIb) on patholog-ical staging , progression of prostate cancer . Methods This retrospective study recruited clinical data of 316 prostate cancer patients with mean age of 69 years from Jan.2006 to Mar.2013.The mean PSA before biopsy was 15.7μg/L.All patients underwent CT or MRI and radionuclide bone scan and had not been found local tumor invasion or distant metastasis .Transrectal ultrasound-guided prostate needle biopsy was performed to all candidates , and the preoperative diagnosis was localized prostate cancer .All patients were treated by laparoscopic radical prostatectomy (LRP).In this study, differences of Gleason score in prostatectomy speci-men, positive surgical margin (PSM), capsular invasion, seminal vesical invasion were analyzed between two groups:group A:patients with PNIb;group B:patients with no PNIb.We also studied the concordance of PNI distribution in PNIb and perineural invasion in prostatectomy specimen ( PNIp). Results The overall rate of PNIb was 32.5%.Difference of Gleason score ≤6 (16 in group A, 92 in group B), Gleason score=7 (46 in group A, 87 in group B), Gleason score ≥8 (41 in group A, 34 in group B) was statisti-cally significant (P<0.05).Of these two groups, differences in PSM (75 in group A, 43 in group B), cap-sular invasion (47 in group A, 36 in group B), and seminal vesical invasion (32 in group A, 23 in group B) were of statistical significant (P<0.05).At the multivariable logistic regression analysis , PNIb was inde-pendent predictor of PSM , capsular invasion, seminal vesicle invasion ( OR=11.358, OR=1.785, OR=2.364, P<0.05).All 22 patients with bilateral PNIb had bilateral PNIp .Of 81 patients with unilateral PNIb,55 had bilateral PNIp .The difference of distribution between PNIb and PNIp was of statistical signifi-cant (P<0.001). Conclusions PNIb is useful for evaluating the progression of prostate cancer .