ＰＳＡ最低值為RARP術後病理組織邊緣陽性後導致腫瘤復發的重要預後因子
蘇世桓、邵翊紘、曲元正、甘弘成、劉忠一、林柏宏、虞凱傑、馮思中、莊正鏗、張英勛*
林口長庚紀念醫院泌尿科
Undetectable nadir PSA is a strong predictor for biochemical failure in patients with positive surgical margin after robotics assisted radical prostatectomy
Shih-Huan Su, I-Hung Shao, Yuan-Cheng Chu, Hung-Cheng Kan, Chung-Yi Liu, Po-Hung Lin, Kai-Jie Yu, See-Tong Pang, Cheng-Keng Chuang, Ying-Hsu Chang*
Department of Surgery, Division of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan
Purpose:
Patient with positive margin after radical prostatectomy for localized prostate cancer has a higher risk of biochemical failure. However, the treatment after positive margin was still controversial. The aims of this study were to find out the risk factors for biochemical failure in patients with positive margin after robotics-assisted radical prostatectomy.
Materials and Methods:
We evaluated total 462 patients who received RARP in a single medical center during 2006-2014 with 61 patients with positive margin and didn’t received any treatment before biochemical failure. 1 patient was excluded due to lost following up. PSA level was checked and collected after operation. The lowest PSA level that we can detect in our hospital is < 0.008. Kaplan-Meier Curve and COX regression analysis were used to compared between patient with biochemical failure (n=19) and without biochemical failure (n=41).
Results:
Overall 13.2% patients had positive margin with 31.7% experienced biochemical failure (BCF) during the follow up. The mean followed up months was 43.66 months (42.42 vs. 46.35(BCF). The group of PSA level that achieve the lowest (nadir PSA) <0.008 after operation (biochemical failure rate=4/34) also make significantly difference to whom didn’t (biochemical failure rate=15/26) (p <0.001). Kaplan-Meier curve analyzing also showed significantly difference.
Conclusion:
Nadir PSA < 0.008 can be a predictor of biochemical failure in patients who received RARP with positive margin. If those patients didn’t achieve nadir PSA level under < 0.008 after operation, we strongly suggested early intervention should be applied in these patients.