CAJ | 학술논문

目的分析影响根治性前列腺切除术(RP)后患者生化复发的危险因素.方法回顾性分析2002年5月至2013年12月在复旦大学附属肿瘤医院泌尿外科接受RP治疗的1 090例前列腺癌患者的临床、病理及随访资料.患者年龄41～84岁,平均67.9岁;术前前列腺特异抗原(PSA)为3.2 ～ 256.3 μg/L,平均32.7μg/L.临床分期中T1期占20.09％ (219/1 090),T2期占50.09％(546/1 090),T3期占29.82％(325/1090).采用Kaplan-Meier法绘制生化复发生存曲线.将临床及病理资料纳入单因素和多因素的Cox回归模型进行分析.结果全组1 090例行RP患者1年无生化复发率为95.99％,3年无生化复发率为81.90％,5年无生化复发率为70.89％.经单因素分析发现确诊时PSA水平(P =0.000)、是否接受新辅助内分泌治疗(P =0.001)、术前Gleason评分(P=0.000)、临床分期(P =0.010)、手术切缘状态(P=0.028)、术后Gleason评分(P =0.000)、术后病理分期(P =0.000)、是否有盆腔淋巴结转移(P =0.000)与患者术后生化复发有关.进一步的Cox多因素分析认为仅有确诊时PSA水平(P =0.000)、术前Gleason评分(P=0.020)、术后病理分期(P=0.014)和是否伴有盆腔淋巴结转移(P=0.017)是影响患者生化复发的独立危险因素.结论确诊时PSA水平、术前Gleason评分、术后病理分期和是否伴有盆腔淋巴结转移是影响RP后患者生化复发的独立预后因素.
목적 분석영향근치성전렬선절제술(RP)후환자생화복발적위험인소.방법 회고성분석2002년5월지2013년12월재복단대학부속종류의원비뇨외과접수RP치료적1 090례전렬선암환자적림상、병리급수방자료.환자년령41～84세,평균67.9세;술전전렬선특이항원(PSA)위3.2 ～ 256.3 μg/L,평균32.7μg/L.림상분기중T1기점20.09％ (219/1 090),T2기점50.09％(546/1 090),T3기점29.82％(325/1090).채용Kaplan-Meier법회제생화복발생존곡선.장림상급병리자료납입단인소화다인소적Cox회귀모형진행분석.결과 전조1 090례행RP환자1년무생화복발솔위95.99％,3년무생화복발솔위81.90％,5년무생화복발솔위70.89％.경단인소분석발현학진시PSA수평(P =0.000)、시부접수신보조내분비치료(P =0.001)、술전Gleason평분(P=0.000)、림상분기(P =0.010)、수술절연상태(P=0.028)、술후Gleason평분(P =0.000)、술후병리분기(P =0.000)、시부유분강림파결전이(P =0.000)여환자술후생화복발유관.진일보적Cox다인소분석인위부유학진시PSA수평(P =0.000)、술전Gleason평분(P=0.020)、술후병리분기(P=0.014)화시부반유분강림파결전이(P=0.017)시영향환자생화복발적독립위험인소.결론 학진시PSA수평、술전Gleason평분、술후병리분기화시부반유분강림파결전이시영향RP후환자생화복발적독립예후인소.
Objective To analyze the risk factors to impact biochemical recurrence after radical prostatectomy.Methods A total of 1 090 patients who received radical prostatectomy from May 2002 to December 2013 in Department of Urology of Fudan University Shanghai Cancer Center were recruited.The average age of the patients was 67.9 years (ranged from 41 to 84 years) and the average preoperative prostate specific antigen (PSA) level was 32.7 (ranged from 3.2 to 256.3) μg/L.The distribution of patients with respect to clinical stage was:20.09％ (219/1 090) had T1,50.09％ (546/1 090) had T2 and 29.82％ (325/1 090) had T3.The biochemical-free-survival curve was drawn by Kaplan-Meier method and the univariate and multivariate Cox regression models were used to evaluate the clinical and pathological variables for the development of biochemical recurrence.Results Of all the 1 090 patients,the biochemical recurrence free survival was 95.99％,81.90％ and 70.89％ at 1,3 and 5 years.PSA level at diagnosis (P =0.000),neo-adjuvant hormonal therapy (P =0.001),pre-operative Gleason score (P =0.000),clinical stage (P =0.010),surgical margin status (P =0.028),post-operative Gleason score (P =0.000),pathological stages (P =0.000) and pelvic lymph-node metastasis (P =0.000) were associated with biochemical recurrence in the univariate analysis.However,in the multivariate analysis,only PSA level at diagnosis (P =0.000),pre-operative Gleason score (P =0.020),pathological stages (P =0.014) and pelvic lymph-node metastasis (P =0.017) were independent prognostic factors.Conclusion For the patients who received radical prostatectomy,PSA level at diagnosis,pre-operative Gleason score,pathological stages and pelvic lymph-node metastasis status are independent prognostic factors for biochemical recurrence.