【摘要】 目的探讨高龄前列腺癌患者术后组织病理学特征及术后病理分期为局部晚期前列腺癌的危险因素。方法回顾性分析421例于我院经前列腺穿刺活检诊断为前列腺腺癌并行腹腔镜前列腺癌根治性切除术患者的临床资料及术后组织病理学资料。临床资料包括患者年龄、前列腺特异性抗原(PSA)、临床分期、穿刺Gleason评分、穿刺阳性百分比;术后组织病理学资料包括患者大体病理Gleason评分、病理分期、切缘情况等。依患者年龄将患者分为高龄组(≥75岁)和对照组(<75岁),比较不同年龄分组前列腺癌患者临床资料及术后组织病理学资料,多因素Logistic回归分析影响前列腺癌患者术后病理结果为局部晚期前列腺癌的危险因素。结果本组患者年龄<75岁者288例(68.4%),年龄≥75岁者133例(31.6%),所有患者均行腹腔镜前列腺根治性切除术,术后大体病理提示Gleason评分6分、7分和≥8分者分别为107例(25.4%)、173例(41.1%)和141例(33.5%),病理分期T2期者和T3期者分别为279例(66.3%)和142例(33.7%);pT3期前列腺癌患者中包膜侵犯者和精囊侵犯者分别为133例(31.6%)和40例(9.5%),另外术后病理提示淋巴结转移者11例(2.6%),切缘阳性者126例(29.9%)。不同年龄分组前列腺癌患者术后Gleason评分无显著性差异(P=0.658);高龄前列腺癌患者术后病理分期偏晚,局部晚期(pT3期)前列腺癌明显增多(P=0.010),特别是包膜侵犯的发生率明显增高(P=0.047);不同年龄分组前列腺癌患者术后病理诊断精囊侵犯(P=0.475)、淋巴结阳性(P=0.748)及切缘阳性(P=0.648)等未见显著性差异。应用多因素Logistics回归分析显示患者高龄(≥75岁)(P=0.005)、穿刺前PSA≥20ng/mL(P<0.001)和穿刺Gleason评分≥8分(P=0.001)是术前预测腹腔镜前列腺根治性切除术后病理分期为局部晚期前列腺癌的独立危险因素。结论高龄(≥75岁)前列腺癌患者经腹腔镜前列腺根治性切除术后病理分期相对较晚,包膜侵犯发生率明显增高。高龄、穿刺前PSA≥20ng/mL和穿刺Gleason评分≥8分是术后病理分期为局部晚期前列腺癌的独立危险因素,在临床工作中应予以重视。更多还原

【Abstract】 Objective By comparatively analyzed the clinical data and pathological data of elder patients with prostate cancer who underwent laparoscopic radical prostatectomy, we will assess the effects of age on histo-pathological outcomes and find out the preoperative risk factors for pathological locally advanced prostate cancer. Methods We retrospectively evaluated 421 patients who were biopsy proved prostatic carcinoma and performed laparoscopic radical prostatectomy. Clinical variables included age, body mass index(BMI), pre-biopsy PSA level, clinical stage, percentage of positive needles, biopsy Gleason Score(GS). All patients were divided into two groups according to age. Histo-pathological parameters included pathological Gleason Score, pathological stage and surgical margins status. Preoperative clinical variables and postoperative histo-pathological parameters were compared among two groups. Multiple logistic regression analysis was performed to predict the factors for pathological locally advanced prostate cancer. Results There were 288 case with younger than 75 years old and 133 cases with 75 years old or older. All patients received laparoscopic radical prostatectomy. There were 107 cases(25.4%), 173 cases(41.1%) and 141 cases(33.5%) for pathological Gleason score 6, 7 and ≥8. There were 279 cases(66.3%) and 142 cases(33.7%) staged for pT2 and pT3 based on postoperative pathological test. In pT3 patients, 133 cases(31.6%) had an extra-capsular extension and 40 cases(9.5%) had a seminal vesicle involvement. There were 11 cases(2.6%) with lymph nodes metastasis and 126 cases(29.9%) with positive surgical margin. Pathological Gleason scores showed no significant difference between two age groups(P =0.658). pT3(P =0.010) and extra-capsular extension(P =0.047) were identified more frequently in the elderly patients. There were no significant differences between two groups in seminal vesicle involvement(0.475), lymph nodes metastasis(0.748) and positive surgical margin(0.648). Multiple logistic Regression analysis showed that 75 years old or older(P =0.005), pre-biopsy PSA≥20 ng/mL(P <0.001) and biopsy Gleason score≥8(P =0.001) were all independent risk factors for pathological locally advanced prostate cancer. Conclusion The pathological grade of elder patients with prostate cancer after laparoscopic radical prostatectomy is frequently late stage. Aged≥75 years, pre-biopsy PSA≥20 ng/mL and biopsy Gleason score≥8 were independent risk factors for pathological locally advanced prostate cancer.更多还原