楊哲學、林益聖、翁瑋駿、黃立華、歐宴泉、許兆畬、童敏哲

台中童綜合醫院 外科部 泌尿科

Che-Hsueh Yang, Yi-Sheng Lin, Wei-Chun Weng, Yen-Chuan Ou, Li-Hua Huang, Chao-Yu Hsu, Min-Che Tung

Division of Urology, Department of Surgery

Tungs’ Taichung MetroHarbor Hospital, Taichung

Taiwan

 

Purpose: In terms of biochemical recurrence (BCR), seminal vesicles invasion (SVI, pT3b) is documented to be worse than positive surgical margin (PSM) or extracapsular extension (ECE, pT3a), and further negatively affects cancer specific-free survival, and all-cause mortality. We objectively reviewed the pT3bN0M0 patients with BCR to analyze the contributing factors.

Materials and Methods: From 2008 to 2011, we retrospectively reviewed 172 patients receiving robotic-assisted radical prostatectomy (RARP) with surgical specimen of pT3bN0M0 by single surgeon. They all initially had their PSA at nadir after RARP, and would be grouped to BCR group if BCR existed, defined as PSA ≥ 0.2 ng/ml after recheck. The others would be categorized into non-BCR group. Two groups were compared with t-test and Pearson's chi-squared test under SAS 9.4 software. P<0.05 would be considered as significance.

Results: With Median 9-year follow-up, there were totally 73 men (42.4%) in BCR groups. Basic data, such as age (p= 0.922), body height (p= 0.2498), body weight (p= 0.8283), BMI (p= 0.8283) were all no different both groups. Pre-operatively, pre-operative PSA, and positive biopsy chips all demonstrated no difference. There were more men with biopsy grade group above group 3 in BCR group (26 men (35.6%), compared at 26 men (26.2%) in non-BCR group, p=0.0237). Difference existed between pre-operative clinical stages between them. More patients had original clinical stage above T3 stage in BCR group (30 men (41.1%), compared at 32 men 32.3% in non-BCR group), and more pre-operative biopsy of benign prostate hyperplasia or low grade prostatic intraepithelial neoplasia in group 1 (8 men (11%), compared at 4 men (4%) in non-BCR group) (p=0.0182). More men with BCR had pre-operative assessment of high risk and very high risk (36 men (49.3%), compared at 33 men (33.3%) in non-BCR group, p=0.0011). Total 42.16±14.35 grams of prostate were resected in BCR group, and 40.49±17.46 grams in non-BCR group (p=0.5048). 18.96±11.46 grams in specimen in BCR group were cancer cells (45.79±25.03%, compared at 14.87±14.81 grams (35.13±22.99%) in non-BCR group, p<0.0001). All patients with BCR had pathological Gleason score above 7, and 1 man with non-BCR had it below 7. No difference could be observed in pathological Gleason score (p=0.5342). Anterior lobe invasion (p=0.5353) and peri-neural invasion (p=0.557) both had no significant roles.

Conclusions: Pre-operative biopsy grade group ≥3, clinical T stage above T3, pre-operative assessment as high and very high risk, and more tumors occupy in specimen would predict BCR in pT3bN0M0. Interestingly, more pT3bN0M0 patients with pre-operative biopsy of benign hyperplasia or low grade prostatic intraepithelial neoplasia would experience BCR in follow-ups.