根治性膀胱切除术标本中前列腺癌的检出率及其对预后的影响

Prostate cancer detected in the specimen of radial cystoprostatectomy for bladder cancer and its prognostic impact

目的探讨根治性膀胱切除术标本中前列腺癌的检出率，并评估其对预后的影响。方法回顾性分析2012年6月至2017年6月收治的132例接受根治性膀胱切除术患者的临床资料。年龄37—89岁，平均61．2岁；〈60岁31例，≥60岁101例。89例术前查血清前列腺特异性抗原（PSA），其中21例4ng／ml〈tPSA〈10ng／ml，1例tPSA17ng／ml，67例tPSA〈4ng／ml。对术后标本中前列腺癌的部位、范围、Gleason评分等进行统计分析。采用logistic回归分析患者年龄与前列腺癌检出率的关系。结果本组132例，术后膀胱癌病理类型为高级别尿路上皮癌116例（87．9％），膀胱原位癌8例（6．0％），低级别尿路上皮癌6例（4．5％），膀胱神经内分泌癌和印戒细胞癌各I例。术后病理标本中21例（15．9％）检出前列腺癌。21例的Gleason评分：3＋2分1例，3＋3分17例，4＋3分1例，3＋4分1例，4＋5分1例。前列腺癌病变位于单侧14例，双侧7例。病灶〈0．5ml3例，0．5-0．7mll4例，0．8-1．0ml4例。21例年龄41-89岁，平均67．5岁。21例中，3例〈60岁，同年龄段的前列腺癌检出率为9．6％（3／31）；18例≥60岁，同年龄段的前列腺癌检出率为17．8％（18／101）。4例术前血清tPSA异常，平均8．8ng／ml（4．2-17．0ng／m1），12例术前血清tPSA正常，平均2．5ng／ml（1．3-3．7ng／m1），5例术前未查血清PSA。随着患者年龄增加，前列腺癌的检出率增加（OR=1．36，P=0．048）。21例随访5-51个月，无因血PSA升高而接受前列腺癌相关治疗者。结论根治性膀胱切除术标本中前列腺癌的检出率较高，但前列腺受累的临床表现隐匿，因此膀胱癌根治手术中彻底切除前列腺组织是非常必要的。

Objective To study the incidence rate of prostate cancer detected in the specimen of radial cystoprostatectomy for bladder cancer and to evaluate its effect on the prognosis. Methods From June 2012 to June 2017, the clinical data of 132 patients with bladder cancer undergoing radical cystectomy （RCP） were analyzed retrospectively. The average age of 132 patients with bladder cancer was 61.2 years （37 -89 years old）. The serum of PSA of 89 cases out of 132 patients was examined before operation,21 cases 4 ng/ml 〈 tPSA 〈 10 ng/ml, 1 case tPSA 17 ng/ml and 67 cases tPSA 〈 4 ng/ml. The pathology of bladder and prostate, the location and range of prostate cancer and Gleason score and the prognostic effect of prostate cancer was evaluated. Results The 132 patients with bladder cancer, 116 cases （87.9%） were high grade urothelial carcinoma, 8 cases （6.0%） were bladder carcinoma in situ, 6 cases （4.5%） were low grade urothelial carcinoma, 1 case was neuroeudocrine bladder carcinoma and 1 case was signet ring cell carcinoma. The 21 cases of prostate cancer were combined with Gleason score, among which 3 ＋ 2 score in 1 cases,3 ＋3 score in 17 cases,4 ＋3 and 3 ＋4 in 1 cases,and 4 ＋5 score in 1 cases. The lesions were unilateral in 14 cases and bilateral in 7 cases. The lesions were 〈0.5 ml in 3 cases,0.5 -0.7 ml in 14 cases and 0.7 - 1.0 ml in 4 cases. The average age of 21 cases with prostate cancer was 67.5 years old （41 -89 years）. Of the 21 cases of prostate cancer, the serum tPSA was abnormal in 4 cases with an average of 8.8 ng/ml （4.2- 17.0 ng/ml）,the serum tPSA was normal in 12 cases with an average of 2.5 ng/ml （ 1.3 - 3.7 ng/ml）, and the serum PSA in 5 cases was not detected before operation. Three cases of prostate cancer aged less than 60 years old with the detection rate of 9.6% （3/31） ; 18 cases were equal or older than 60 years old with the detection rate of 17.8% （ 18/101 ）. Multi parameter analysis showed that the incidence of prostate cancer increased with the age of the patients （ OR = 1.36 ,P = 0. 048）. Followed up for 5 to 51 months, no PSA relapse was found and no patient receiving related treatment. Conclusions The detection rate of prostate cancer is very high in the specimen of radial cystoprostatectomy for bladder cancer. The clinical manifestation of the prostatic involvement is concealed. Radical resection of the prostate is necessary in radical resection of bladder cancer.