前列腺癌生化复发危险因素报告--单中心11年回顾分析

Risk factors for biochemical recurrence of prostate cancer:a single-center 11-year retrospective analysis

目的探讨前列腺根治性切除术(RP)后生化复发的危险因素。方法收集2010年1月至2020年12月苏州大学附属第二医院泌尿外科收治的559例RP患者的临床资料,排除失访及随访资料不完整的患者,总共纳入384例接受腹腔镜前列腺根治性切除术的患者进行回顾性分析。生化复发定义为术后随访过程中连续2次PSA>0.2 ng/ml。根据患者术后是否出现生化复发分为生化复发组和未生化复发组。采用Kaplan-Meier法绘制无生化复发生存曲线,采用Logrank法进行单因素分析,对单因素分析有意义的指标采用Cox比例风险模型进行多因素分析。对多因素分析中有意义的独立危险因素分别单独赋值,并构建生化复发预测模型。结果随访时间3~135个月,中位随访时间41(26,62)个月,共有115例患者出现生化复发,总体生化复发率为29.95%。术后3年和5年无生化复发生存率分别为74.0%和69.2%。单因素分析结果显示,生化复发组与未生化复发组在术前PSA、游离PSA、穿刺Gleason评分、临床分期、前列腺特异抗原密度、术后病理Gleason评分升级、精囊侵犯、神经侵犯、淋巴结阳性和标本切缘阳性上差异有统计学意义(P<0.05)。Cox多因素分析显示,PSA≥23.25 ng/ml(P=0.002)、穿刺Gleason评分≥4+3分(P=0.009)、术后病理Gleason评分出现升级(P=0.003)、病理淋巴结阳性(P<0.001)和精囊侵犯(P=0.016)是患者接受根治手术后出现生化复发的独立危险因素。结论PSA≥23.25 ng/ml、穿刺Gleason评分≥4+3分、术后病理Gleason评分升级、病理淋巴结阳性和精囊侵犯是患者接受根治手术后出现生化复发的独立危险因素。需要对符合预测模型中风险和高风险的患者进行密切的术后随访。

Objective To investigate the risk factors of biochemical recurrence after radical prostatectomy(RP).Methods Clinical data of 559 RP patients admitted to the Department of Urology of the Second Affiliated Hospital of Soochow University from January 2010 to December 2020 were collected,and a total of 384 patients were included for retrospective analysis,excluding those with lost follow-up and incomplete follow-up data.Biochemical recurrence was defined as two consecutive PSA>0.2 ng/ml during the postoperative follow-up.Patients were divided into biochemical recurrence group and non-biochemical recurrence group according to whether biochemical recurrence occurred after surgery.Kaplan-meier method was used to plot the survival curve without biochemical recurrence,log-rank method was used for univariate analysis,and Cox proportional risk model was used for multivariate analysis of indexes that were significant for univariate analysis.The significant independent risk factors in multivariate analysis were assigned values separately,and the prediction model of biochemical recurrence was constructed.Results The follow-up time was 3-135 months,and the median follow-up time was 41(26,62)months.A total of 115 patients had biochemical recurrence,and the overall biochemical recurrence rate was 29.95%.The 3-year and 5-year recurrence free survival rates were 74.0%and 69.2%,respectively.Univariate analysis showed that there were statistically significant differences between the recurrence group and the non-recurrence group in preoperative PSA,free PSA,Gleason score by punc-ture,clinical stage,PSA density,postoperative pathological Gleason score upgrade,seminal vesicle invasion,nerve invasion,posi-tive lymph node and positive specimen resection margin(P<0.05).Cox multivariate analysis showed that PSA≥23.25 ng/ml(P=0.002),Gleason score by puncture≥4+3(P=0.009),postoperative pathological Gleason score upgrade(P=0.003),positive lymph node(P<0.001)and seminal vesicle invasion(P=0.016)were independent risk factors for biochemical recurrence after radical surgery.Conclusions PSA≥23.25 ng/ml,Gleason score by puncture≥4+3,postoperative pathological Gleason score upgrade,positive lymph node and seminal vesicle invasion were independent risk factors for biochemical recurrence after radical surgery.Patients who fit the risk and high-risk models need to be closely followed up after surgery.