機械手臂攝護腺切除術後邊緣陽性病患的生化指標復發風險預估因子
簡維弘、邵翊紘、甘弘成、劉忠一、林柏宏、虞凱傑、張英勛、吳俊德、馮思中、莊正鏗
林口長庚紀念醫院 外科部 泌尿科系
基隆長庚紀念醫院 外科部 泌尿科系
Predictors for biochemical failure in patients with positive surgical margin after robotic-assisted radical prostatectomy
Wei-Hung Chien1; I-Hung Shao1; Hung-Cheng Kan1; Chung-Yi Liu1; Po-Hung, Liu1; Kai-Jie, Yu1; Ying-Hsu Chang1; Chun-Te Wu2; See-Tong Pang1; Cheng-Keng Chuang1
1Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
2Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelong, Taiwan
Purpose: Robotic-assisted radical prostatectomy (RARP) is known as a more oncological safety procedure compared to radical prostatectomy. Patient with positive margin after operation has a higher risk of biochemical failure. However, the treatment after positive margin was still controversial. The aims of this study was to find out the risk of biochemical failure over patients with positive margin after operation.
Materials and Methods: We evaluated total 462 patients who received RARP at LinKou Chang Gung Memorial Hospital 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. COX regression analysis and Kaplan-Meier Curve 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% turned out to be biochemical failure (BCF). The mean followed up months was 43.66 months ( 42.42 vs. 46.35(BCF), p=0.51). In multivariable analysis, Platelet and Lymphocyte ratio(PL ratio) ( 6.26 vs. 8.02(BCF), p=0.001) showed statistically significant. And, if we separated the patients to two group by pathology grading group <2 and >3 (p=0.001), it also showed statistically significant. Kaplan-Meier Curve was also used to analyze when PL ratio <=9 or >9 and it showed p value = 0.017.
Conclusions: If patients who received RARP with positive margin had PL ratio >9 by pre-operation lab data and pathology grading group >3, we strongly suggested early intervention should be applied over these patients.