机器人辅助腹腔镜根治性前列腺切除术中移行带前列腺癌切缘阳性的危险因素

Analysis of risk factors of positive surgical margin in robot-assisted radical prostatectomy in the treatment of transitional zone prostate cancer

目的探讨机器人辅助腹腔镜根治性前列腺切除术(RARP)在处理前列腺移行带肿瘤时发生切缘阳性的危险因素。方法回顾性分析2015年7月至2019年7月我院收治的150例临床局限性移行带前列腺癌患者的病例资料。所有患者均行RARP,术后病理明确诊断为移行带前列腺癌。对切缘阴性和切缘阳性两组患者的临床和病理相关指标单因素及多因素Logistic回归分析,明确术后发生切缘阳性的相关因素。结果多因素分析结果显示,手术方式、前列腺体积、累及双叶和包膜侵犯与术后切缘阳性相关(P<0.05)。保留Retzius间隙的术式(RS-RARP)(OR=8.208,95%CI:1.961~34.353,P=0.004)、累及双叶(OR=6.453,95%CI:1.117~37.279,P=0.037)和包膜侵犯(OR=16.822,95%CI:2.998~94.387,P=0.001)是RARP处理移行带前列腺癌时发生切缘阳性的独立危险因素,而前列腺体积(OR=0.957,95%CI:0.919~0.996,P=0.033)对切缘具有保护作用。结论肿瘤分期和保留Retzius间隙术式是RARP在处理移行带前列腺癌时发生切缘阳性的独立危险因素。

Objective To investigate the risk factors of positive surgical margin(PSM)in robot-assisted radical prostatectomy(RARP)in the treatment of transitional zone prostate cancer.Methods Clinical data of 150 patients with transitional zone prostate cancer treated during July 2015 and July 2019 were retrospectively analyzed.All patients underwent RARP and were confirmed.Patients were divided into negative surgical margin group and positive surgical margin group.The clinical and pathological indicators were compared with multivariate Logistic regression analysis to identify factors related to PSM.Results Multivariate analysis showed that surgical approach,prostate volume,bilateral lobe involvement and capsule invasion were related to PSM(P<0.05).Retzius-sparing RARP(RS-RARP)(OR=8.208,95%CI:1.961-34.353,P=0.004),bilateral lobe involvement(OR=6.453,95%CI:1.117-37.279,P=0.037)and capsule invasion(OR=16.822,95%CI:2.998-94.387,P=0.001)were independent risk factors of PSM.Prostate volume(OR=0.957,95%CI:0.919-0.996,P=0.033)was a protective factor against PSM after RARP.Conclusion Tumor stage and Retzius-sparing are independent risk factors of PSM in RARP in the treatment of transitional zone prostate cancer.