根治性前列腺切除术中前列腺前脂肪垫淋巴结及肿瘤转移临床分析

Landscape and metastases of the lymph nodes in prostatic anterior fat pad at radical prostatectomy

目的评估接受根治性前列腺切除术(RP)患者的前列腺前脂肪垫(PAFP)中淋巴结及肿瘤转移情况,初步探讨PAFP淋巴结转移患者的临床特征。方法回顾性分析2019年12月至2021年8月在中山大学肿瘤防治中心泌尿外科接受RP的287例前列腺癌患者的临床和病理学资料。患者均为男性,年龄(66±7)岁(范围:42~83岁),术前前列腺特异性抗原[M(IQR)]为16.00(29.64)μg/L(范围:0.01~99.90μg/L)。244例患者为局限性或局部晚期,43例为转移性前列腺癌。所有患者术中常规切除PAFP并单独病理学送检;PAFP切除范围:尾侧至前列腺尖部,头侧至膀胱颈,两侧至前列腺与盆内筋膜连接处。217例患者接受盆腔淋巴结清扫术。所有PAFP病理标本均经泌尿系肿瘤亚专科的病理科医师阅片及报告。组间比较采用独立样本t检验、Wilcoxon秩和检验、χ^(2)检验或Fisher确切概率法。结果287例患者中,23例(8.0%)PAFP存在淋巴结,11例(3.8%)PAFP存在淋巴结转移。1例患者PAFP存在淋巴结转移而无其他盆腔淋巴结转移。4例患者的PAFP存在脂肪结缔组织受侵。PAFP存在淋巴结转移的患者,术前前列腺特异性抗原[M(IQR)]更高[48.2(73.0)μg/L比15.4(26.5)μg/L,Z=3.158,P=0.002],临床T分期和N分期更晚(Z=2.977,P=0.003;Z=2.780,P=0.005),术前Gleason评分更高(Z=2.205,P=0.027)。结论RP术中常规切除PAFP并单独送病理学检查,可能检出更多的盆腔淋巴结和转移淋巴结,可能获得更准确的病理学N分期。

Objectives To examine the landscape and metastases of the lymph nodes in prostatic anterior fat pad(PAFP)at radical prostatectomy(RP),and to describe the clinical characteristic of the patients with lymph node metastases in PAFP.Methods The clinical and pathological data of 287 prostate cancer patients underwent RP from December 2019 to August 2021 in Department of Urology,Sun Yat-sen University Cancer Center were collected and analyzed retrospectively.All patients were male,aging(66±7)years(range:42 to 83 years).The preoperative prostate-specific antigen(PSA)(M(IQR))were 16.00(29.64)μg/L(range:0.01 to 99.90μg/L).There were 244 patients with localized or locally advanced prostate cancer and 43 patients with metastatic prostate cancer.All PAFP were dissected at RP routinely and were sent for pathologic analysis respectively.The PAFP was dissected from the prostate apex caudally toward the bladder neck and dissection extended to the joint of the prostate and the endopelvic fascia bilaterally.All the specimen of PAFP were examined and reported by subspecialty pathologists of genitourinary tumors.Statistical analysis was performed by Student t test,Wilcoxon rank-sum test,χ^(2) test or Fisher exact test.Results There were 8.0%(23/287)patients with lymph nodes in PAFP,3.8%(11/287)patients with PAFP lymph node metastases.Pathologically upstaged occurred in 1 patient due to the PAFP lymph node as the solitary metastatic lesion.Patients with lymph node metastases in PAFP presented higher preoperative PSA(M(IQR):48.2(73.0)μg/L vs.15.4(26.5)μg/L,Z=3.158,P=0.002),clinical T stage and N stage(Z=2.977,P=0.003;Z=2.780,P=0.005)and preoperative Gleason score(Z=2.205,P=0.027).Conclusions Routine dissection of PAFP at RP and separately pathological analysis may allow more lymph nodes and lymph node metastases detection.More accurate pathological N stage may be acquired and consequently may improve the survival of patients by offering more appropriate adjuvant or salvage therapy.