前列腺癌根治术后无瘤生存期的影响因素分析

Analysis of factors influencing the disease-free survival after radical prostatectomy for prostate adenocarcinoma

目的探讨前列腺癌根治术后无瘤生存期的影响因素及Bcl2、CerbB2、Ki67在前列腺癌中的表达及意义。方法回顾性分析51例前列腺癌患者根治术后无瘤生存期的影响因素,应用Cox比例风险模型进行多因素统计分析。对其中15例术前穿刺标本及手术切除标本行3种癌基因蛋白免疫组化检查,分析其表达与术后无瘤生存期的关系。结果Cox比例风险模型发现有意义的因素为年龄(P=0.011)、术前雄激素全阻断治疗(P=0.017)、阳性切缘(P=0.000)、切除标本Gleason评分(P=0.002)、术前或术后行睾丸切除(P=0.040)。前列腺癌穿刺标本、切除标本中Bcl2、CerbB2、Ki67蛋白表达与术后无瘤生存期存在相关性。结论标本阳性切缘是影响无瘤生存期的因素,前列腺癌根治术术前雄激素全阻断治疗可提高患者术后无瘤生存期,术中探查未发现肿大淋巴结时未行盆腔淋巴结清扫对术后无瘤生存时间无明显影响,术前或术后睾丸切除患者的无瘤生存期明显好于未行睾丸切除患者。Ki67、Bcl2与CerbB2可作为术前、术后预测前列腺癌患者根治术后无瘤生存期的指标。

Objective To analyze the factors that influence the disease-free survival time after radical prostatectomy for prostate adenocarcinoma and to study the expression and significance of Bcl-2,C-erbB-2,Ki-67 in prostate adenocarcinoma. Methods A total of 51 cases of prostate adenocarcinoma undergoing radical prostatectomy were reviewed.Cox proportional hazard model was used to investigate the impact and co-impacts of the factors,which included age, preoperative PSA level,Gleason scores of biopsies and operative specimens,EPE,MR,SVI,LN,PAT,PRT and having testes or not during follow-up.Immunohistochemical staining was used in biopsies and resected specimens to evaluate the positivity of Bcl-2,C-erbB-2,Ki-67 in 15 of the 51 cases. Results In stepwise Cox proportional hazards model, the prognostic factors for recurrence were age(P=0.011),maximal androgen blockade(P=0.017), positive margin of resection(P=0.000),postoperative Gleason score(P=0.002),having testes or not after operation(P=0.040).The expressions of 3 types of proteins showed negative correlation with the prognosis of prostate carcinoma. Conclusions Among clinicopathologic factors,positive resected margin is the most powerful prognostic factor.Patients will benefit from maximal androgen blockage before radical prostatectomy.Disease-free survival after radical prostatectomy is not influenced by not having pelvic lymphadenectomy after finding no enlarged lymph nodes intraoperatively.Not preserving testes after prostatectomy is a favorable factor.The prognosis of prostate carcinoma can be predicted with the expressions of Bcl-2,C-erbB-2 and Ki-67 in biopsies or resected specimens.