前列腺癌患者根治术后生化复发危险因素的单中心研究

Risk factors for biochemical recurrence after radical prostatectomy： a single center analysis

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.

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＆#39;s conclusions.