【作者】 陈军；

【导师】 金百冶；

【作者基本信息】 浙江大学 ， 外科学， 2015， 硕士

【摘要】 目的：探讨膀胱前列腺切除术标本中的前列腺偶发癌的发生率和临床病理特点,以提高对膀胱癌伴前列腺偶发癌的诊治水平。方法：回顾性分析2004年1月至2014年6月浙江大学附属第一医院泌尿外科收治的786例行膀胱前列腺切除术的膀胱癌患者的前列腺标本和临床资料,所有患者在术前常规行直肠指检、泌尿系统B超、血清PSA、胸部X线,术前均未发现前列腺癌迹象。结果：786例患者中有103例(13.10%,103/786)发现前列腺偶发癌,大部分(100/103,97.09%)为局限性前列腺癌(分期在pT2以内),3例(2.91%)为pT3。Gleason评分<6分87例(87/103,84.47%),≥7分16例(16/103,15.53%)。前列腺偶发癌的发生率与年龄显著正相关(P<0.05)。其中26例为有临床意义的前列腺偶发癌(26/103,25.24%)。伴前列腺偶发癌和无前列腺偶发癌的膀胱前列腺切除术患者两组间血清PSA水平无显著性差异(P>0.05)；有临床意义的前列腺偶发癌和无临床意义的前列腺偶发癌两组间血清PSA水平无显著性差异(P>0.05)。共96例前列腺偶发癌患者获得随访,平均随访时间为(38.60±17.37)月。6例(6.25%,6/96)患者发生生化复发,有临床意义的前列腺偶发癌和无临床意义的前列腺偶发癌两组间生化复发率有显著性差异(P<0.01),随访期间无前列腺癌相关死亡。有临床意义的前列腺偶发癌和无临床意义的前列腺偶发癌两组间肿瘤特异性生存率无显著性差异(P>0.05)。结论：本研究膀胱前列腺切除术后标本中前列腺偶发癌的发生率为13.10%,与年龄正相关；大部分前列腺偶发癌为局限性前列腺癌,且分化良好；临床病理诊断时前列腺标本充分包埋和超薄厚度充分取材可以提高前列腺偶发癌检出率；对于行膀胱前列腺切除术的患者术前要做全面详尽的前列腺相关检查,尤其是60岁以上的患者,应尽量减少前列腺偶发癌漏诊；术前血清PSA无法预测前列腺偶发癌,但可以用于监测前列腺偶发癌的预后；前列腺偶发癌对膀胱癌行膀胱前列腺切除术患者的预后无明显影响。更多还原

【Abstract】 Objective:To investigate the incidence and clinicopathological features of incidental prostate cancer (IPCa) in radical cystoprostatectomy (RCP) specimens for bladder cancer, so as to improve the diagnosis and treatment for bladder cancer combined with IPCa.Methods:The prostate specimens and clinical data of786cases who underwent RCP between January2004and June2014in the First Affiliated Hospital of Zhejiang University were analysed retrospectively. All patients underwent digital rectal examination (DRE) and ultrasonography and serum PSA test and chest X-ray. No patients had preoperative clinical or biological suspicion of PCa.Results:IPCa was diagnosed in103of786(103/786,13.10%) cases. Most tumors (100/103,97.09%) were organ-confined (≤pT2); And3cases (3/103,2.91%) were diagnosed at pT3. Gleason score was≤6in87cases (87/103,84.47%), and≥7in16cases (16/103,15.53%). The incidence of IPCa increased with age (P<0.05). Of these IPCa patients,26cases (26/103,25.24%) were clinically significant according to an accepted definition. No significant differences were found in the serum PSA level between patients with IPCa and these without IPCa, nor between patients with significant IPCa and insignificant IPCa(P>0.05).96patients with IPCa were followed up at a mean follow-up period of (38.60±17.37)months. Biochemical recurrence occured in6patients (6/96,6.25%). Significant differences were found in the rate of biochemical recurrence between the clinically significant and insignificant IPCa group(P<0.01). None of these ICPa patients died of IPCa. No significant differences were found in cancer specific survival between the clinically significant and insignificant IPCa group (P>0.05).Conclusion:The incidence of IPCa in RCP specimens was13.10%, which increased with age. Most IPCas in RCP specimens were organ-confined and well-differentiated. Fully drawn of prostate tissue in RCP specimens can improve the detection rate of IPCa. In order to reduce the missed diagnosis of IPCa, a comprehensive examination of prostate should be taken to patients who undergo RCP, especially in these patients over the age of60. Serum PSA level cannot identify asymptomatic PCa prior to RCP, but it is helpful in the prediction of prognosis of IPCa. IPCa doesn’t impact the prognosis of bladder cancer patients undergoing RCP.更多还原