腹腔镜下根治性前列腺切除术后的肿瘤学和功能学结局:10年随访

Oncologic and functional outcomes after laparoscopic radical prostatectomy:10-years follow-up

目的评估腹腔镜下根治性前列腺切除术(laparoscopic radical prostatectomy,LRP)后长期控尿功能、性功能和疾病复发、总体死亡以及前列腺癌特异性死亡风险。方法回顾性随访2009年6月至2013年12月于首都医科大学附属北京朝阳医院泌尿外科进行LRP的99例患者的肿瘤学结局和功能学结局。根据纳入和排除标准,最终80例患者纳入研究。采用Cox回归分析患者LRP术后总生存时间(overall survival,OS)、肿瘤特异生存时间(cancer specific survival,CSS)、影像学无进展生存时间(radiologic progression-free survival,rPFS)的影响因素。结果LRP术后前列腺癌患者的5年和10年总生存率分别为86%和70%,肿瘤特异生存率分别为91%和85%,无影像学进展生存率分别为87%和76%。Gleason评分及术后未达到临床治愈是影响患者OS的独立危险因素,病理Gleason评分是影响患者CSS的独立危险因素,术前最高前列腺特异性抗原(prostate specific antigen,PSA)浓度大于20 ng/mL是影响患者rPFS的独立危险因素,但术后未达到临床治愈对CSS、rPFS的影响仅具有边缘性显著性意义。LRP术后76.8%的患者能够完全控尿,21.4%的患者存在不同程度尿失禁,51.8%的患者没有性刺激或者性兴奋,12.5%的患者仍可以正常进行性生活,35.7%的患者存在勃起功能障碍不足以维持正常的性生活,术中未保留血管神经束的患者勃起功能障碍发生率比保留者发生率更高。结论前列腺癌患者接受LRP后,长期的控瘤和控尿功能基本与国外报道相似,采用LRP治疗前列腺癌可以获得非常好的肿瘤学和功能学结局。

Objective To assess long-term urinary control function,sexual function and disease recurrence,overall mortality,and risk of death from prostate cancer after laparoscopic radical prostatectomy(LRP).Methods Oncologic outcomes and functional outcomes were analyzed retrospectively in 99 patients who underwent LRP from June 2009 to December 2013.Finally 80 patients were included in the study according to the exclusion criteria.Cox regression was used to analyze the risk factors for overall survival(OS),cancer-specific survival(CSS),and radiologic progression-free survival(rPFS)after LRP.Results The 5-year and 10-year OS rates after LRP were 86%and 70%,the CSS rates were 91%and 85%,and PFS rates were 87%and 76%,respectively.Pathological Gleason score and failure to achieve clinical cure after surgery were independent risk factors for OS,pathological Gleason score was an independent risk factor for CSS,and the highest preoperative prostate specific antigen(PSA)level>20 ng/mL was an independent risk factor for PFS,but failure to achieve clinical cure after surgery had a marginal significance on CSS and PFS.The rate of urinary continence was 76.8%,21.4%had urinary incontinence to varing degree,51.8%had no sexual stimulation or arousal,12.5%had normal sexual activity,and 35.7%had erectile dysfunction insufficient to maintain normal sexual activity,and the incidence of erectile dysfunction was higher in patients without preserving vascular nerve bundles than those with preservation during LRP.Conclusion The 10-year long-term outcomes of oncology and urinary continence after LRP are similar to the previous reports,LRP is an optimal option to achieve satisfactory oncological and functional outcomes for patients with prostate cancer.