耻骨后前列腺癌根治术中切缘阳性的相关因素分析

Study on factors of surgical margin in prostate cancer after radical retropubic prostatectomy

目的探讨相关临床参数对前列腺癌根治术切缘阳性率的影响。方法研究对象为128例经病理证实并实施前列腺癌根治术的前列腺癌患者，通过回顾性研究了解病理分期、术前血清前列腺特异性抗原（PSA）、穿刺后Gleason评分、穿刺针数阳性百分率对手术切缘阳性的影响。结果128例前列腺癌患者术后切缘阳性率为17.19％（22／128）。病理分期与手术切缘阳性战正相关（r=0．352，P=0．001），且对手术切缘阳性有统计学意义（χ^2=18．732，P=0．001）。对于手术切缘阳性率，术前血清PSA〈10ng／mL组与血清PSA≥10ng／mL组比较，差异有统计学意义（χ^2=7．130，P=0．008）；穿刺后Gleason评分〈7分组与Gleason评分≥7分组差异无统计学意义（χ^2=0．456，P=0．500）；对比穿刺针数阳性百分率，≤33．3％组与〉33．3％组差异有统计学意义（χ^2=5．113，P=0.024）。结论穿刺后Gleason评分对前列腺癌根治术中切缘阳性无影响，而病理分期、血清PSA、穿刺阳性百分率对手术切缘阳性有意义，同时手术者经验和手术技能对手术切缘阳性有一定影响。

Objective To study the preoperative factors associated with surgical marginal status in patients who underwent radical prostatectomy for prostate cancer. Methods The retrospective study recruited 128 patients with prostate cancer underwent radical retropubic prostatectomy to access the impact of pathological stage, PSA, Gleason scores and positive percentage of the needle biopsy on positive surgical margins. Results The overall margin positivity rate was 17.19% （22/128）. We found positive correlation （r=0.352, P=0.001） between pathologic staging and positive surgical margin, and the difference was statistically significant （χ2=18.732, P=0.001）. There was significant difference （χ2 =7.130, P=0.008） observed between the serum PSA ≥ 10 ng/mL and PSA 〈 10 ng/mL groups, There was no significant difference （χ2=0.456, P=0.500） observed between Gleason score〈7 and Gleason score≥7 groups. We also studied the positive percentage of the needle biopsy of all cases, the difference was significant （χ2=5. 113, P=0.024） between positive rate ≤33.3 % and positive rate 〉 33.3 % groups. Conclusions There is no significant positive impact of Gleason score to the positive surgical margin of patients with prostate cancer underwent radical resection. Pathological stage, PSA and positive percentage of the needle biopsy have significant impacts on positive surgical margins, and surgical skills also have certain impacts on positive surgical margin.