CAJ | 학술논문

目的回顾性分析前列腺癌患者根治术后生化复发生存曲线及其危险因素.方法回顾性分析我院2000年5月至2015年3月1 122例行根治手术的前列腺癌患者资料.排除失访及术前、术后进行辅助治疗患者,883例纳入研究.生化复发定义为患者术后未进行内分泌治疗及放疗,随访过程中连续2次前列腺特异性抗原(PSA) ≥0.2 μg/L.使用Kaplan-Meier法绘制无生化复发生存曲线,采用Log-rank对确诊时年龄,术前PSA,手术方式,不同手术方式下早、中、后期手术,术后病理情况(包膜是否侵犯、精囊是否侵犯、切缘是否阳性、区域淋巴结是否转移、术后Gleason评分)进行单因素分析.运用Cox比例风险模型行多因素分析.结果中位随访7个月.883例患者中251例发生生化复发,总生化复发率为28.4％,患者3、5年无生化复发生存率为60.5％和45.3％.术后Gleason评分＞7(HR=1.774,95％ CIl.358～2.316,P＜0.001)、术前PSA≥10 μg/L(HR=1.758,95％ CI 1.288 ～2.399,P＜0.001)和精囊侵犯(HR=1.512,95％ CIl.049 ～2.177,P=0.027)均是前列腺癌患者根治术后生化复发的高危因素.结论术前PSA、精囊侵犯和术后Gleason评分是前列腺癌患者根治术后生化复发的危险因素.需要更大样本量及更长时间的随访研究进行验证.
목적 회고성분석전렬선암환자근치술후생화복발생존곡선급기위험인소.방법 회고성분석아원2000년5월지2015년3월1 122례행근치수술적전렬선암환자자료.배제실방급술전、술후진행보조치료환자,883례납입연구.생화복발정의위환자술후미진행내분비치료급방료,수방과정중련속2차전렬선특이성항원(PSA) ≥0.2 μg/L.사용Kaplan-Meier법회제무생화복발생존곡선,채용Log-rank대학진시년령,술전PSA,수술방식,불동수술방식하조、중、후기수술,술후병리정황(포막시부침범、정낭시부침범、절연시부양성、구역림파결시부전이、술후Gleason평분)진행단인소분석.운용Cox비례풍험모형행다인소분석.결과 중위수방7개월.883례환자중251례발생생화복발,총생화복발솔위28.4％,환자3、5년무생화복발생존솔위60.5％화45.3％.술후Gleason평분＞7(HR=1.774,95％ CIl.358～2.316,P＜0.001)、술전PSA≥10 μg/L(HR=1.758,95％ CI 1.288 ～2.399,P＜0.001)화정낭침범(HR=1.512,95％ CIl.049 ～2.177,P=0.027)균시전렬선암환자근치술후생화복발적고위인소.결론 술전PSA、정낭침범화술후Gleason평분시전렬선암환자근치술후생화복발적위험인소.수요경대양본량급경장시간적수방연구진행험증.
Objective To analyze biochemical recurrence (BCR) survival curve and its risk factors of patients receiving radical prostatectomy.Methods 1 122 patients treated with radical prostatectomy were retrospectively collected from May,2000 to March,2015.The patients who lost follow-up or had adjuvant radiation or hormonal therapy were excluded,the remaining 883 patients were evaluated in the present study.BCR was defined as follow-up prostate specific antigen(PSA) level ≥0.2 μg/L on two separate occasions.Kaplan-Meier curves and Log-rank test were used for univariate anaysis of BCR,including age,preoperative PSA,surgical procedure,early or middle or later period in different surgical manner,pathological status (capsula,seminal vesicle,surgical margin,lymph node status,Gleason score).Cox regression analyses were performed for multivariate analysis.Results At a median follow-up of 7 months,251 out of 883 had BCR,the overall BCR rate was 28.4％.Overall 3-year and 5-year BCR-free survival rates were 60.5％ and 45.3％,respectively.On the multivariate analysis,pathological Gleason score ＞ 7 (HR =1.774,95％ CI 1.358-2.316,P ＜ 0.001),preoperative PSA ≥ 10 μg/L (HR =1.758,95％ CI 1.288-2.399,P ＜ 0.001) and seminal vesicle invasion (HR =1.512,95％ CI 1.049-2.177,P =0.027) were significantly associated with BCR.Conclusions Preoperative PSA,seminal vesicle invasion and pathological Gleason score were found to be risk factors of BCR.Larger study and longer follow-up period are needed to confirm the present study's conclusions.