攝護腺癌經機械手臂輔助攝護腺根除術後包膜外侵犯之生化復發預測因子分析
楊哲學 林益聖 翁瑋駿 黃立華 呂謹亨 歐宴泉 許兆畬 童敏哲
台中童綜合醫院 外科部 泌尿科
Predictive factors analysis on biochemical recurrence among patients of extraprostatic extension alone after robotic assisted radical prostatectomy
Che-Hsueh Yang, Yi-Sheng Lin, Wei-Chun Weng, Li-Hua Huang, Chin-Heng Lu, Yen-Chuan Ou, Chao-Yu Hsu, Min-Che Tung
Division of Urology, Department of SurgeryS
Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
Purpose: The prostate cancer (PCa) of extraprostatic extension (EPE) alone in pathology (pT3a) is proved to have worse prognostic impact on biochemical recurrence (BCR) than organ-confined PCa do. Hence, we launched this review to further examine if any other predictive factors will further contribute to BCR on the basis of pT3a.
Materials & methods: A total 367 patients with pT3a after robotic- assisted radical prostatectomy (RARP) from 2014 to 2018 were retrospectively enrolled. They reached the PSA nadir at first after surgery but reached the BCR, defined as PSA> 0.2 ng/ml in consecutive 2 times with 1-week interval. It was BCR or not that 2 subgroups were categorized into (Group 1: BCR. Group 2: no BCR). Pearson's chi-squared test, student t test, and SAS 9.4 were applied to compared the statistical significance when p<0.05.
Results: All in all, 81(22.44%) patients experienced BCR. Basic characteristics, such as BMI (p=0.6868), age (p=0.1807) and age distribution (p=0.236) were at no significant difference. In group 1, average 4.5±3.52 positive biopsies out of 12.75±3.62 biopsy cores. In the other hand, average 4.74±3.84 positive biopsy out of 13.64±3.71 biopsy cores in group 2. No difference existed neither in positive biopsy (p=0.6712) nor biopsy cores performed (p=0.1065). Pre-operative PSA were at no difference (group 1:23.99 ± 17.36 ng/ml. group 2: 21.57±15.75 ng/ml. p=0.6513). Pre-operative T stage (p=0.0881), and biopsy Gleason grade group (p=0.6886) showed no difference. Significant difference existed in tumor volume (Group 1: 12.38±8.12 g. Group 2: 8.36±7.91 g. p<0.0001), percentages of tumor out of specimen (Group 1: 34.23±17.17%. Group 2: 21.2±15.2 %. p<0.0001), pathological Gleason grade ≥7 (Group 1:77 (96.25%) patients. Group 2: 225 (79.79%) patients. p=0.0005), and pathological primary Gleason score ≥ 4 (Group 1: 50(62.5%) patients. Group 2: 101(35.82%) patients. p=0.0003). There were significant differences in pre-operative PSA distribution (Group 1: <10 ng/ml: 26(32.1%) patients, between 10 and 20 ng/ml: 26(32.1%) patients, >20 ng/ml: 29(35.8%). Group 2: <10 ng/ml :135(47.37%) patients, between 10 and 20 ng/ml: 87 (30.53%) patients, >20 ng/ml :63 patients (22.11%). p=0.0174). Compared with the clinical T stage, upstaging after RARP would not increase the risk of BCR (p=0.1288). Anterior lobe invasion (p=0.3015) and perineural invasion (p=0.1775) were both proved not related to BCE.
Conclusion: More tumor volume, more tumor percentages out of specimen volume, pathological Gleason grade ≥ 7, pathological primary Gleason score ≥ 4, and pre-operative PSA >20 ng/ml will likely enhance the risk of BCE to patients of pT3a after RARP. However, absolute pre-operative PSA value itself not necessarily indicates absolute positive correlation with BCR.