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JU:根治性前列腺癌切除术后切缘为良性腺体组织是否与生化复发相关

2021-09-15 泌尿小王 MedSci原创

理论上讲,RP后血清前列腺特异性抗原(PSA)检测不出来。然而,研究发现,部分患者在接受明确RP治疗后且没有肿瘤复发,仍能检测到PSA,手术切缘的良性腺体组织是否与PSA和/或术后的BCR有关

理论上讲,根治性前列腺癌切除术(RP)后血清前列腺特异性抗原(PSA)检测不出来。然而,研究发现,16.4%的患者在接受明确RP治疗后且没有肿瘤复发,仍能检测到PSA;而对于孤立性膀胱癌,接受膀胱前列腺切除术后可检测到PSA,这一比例高达12%;手术切缘的良性腺体组织(BGM)是否与PSA和/或RP后的生化复发(BCR)相关仍然有待研究。

最近,《The Journal of Urology》发表了一篇研究对该问题进行了研究而结果提示RP时BGM的存在与MSM、PSA检测、BCR或PSA检测后进展的风险增加无关

方法

2004-2018年接受RP的患者,总计1082名。

纳入标准:

(1)纳入研究的患者必须在RP后6个月内有PSA <0.03 ng/ml的记录

(2)术后两次的PSA检测需要在术后8周内完成检测,术后至少随访6个月。

排除标准:

(1)在诊断时患有临床T4、N1或M1疾病的男性或病理性N1疾病的男性被排除在外

(2)在RP之前接受新辅助治疗的患者被排除在外

(3)在RP后6个月内开始辅助治疗的患者

BCR定义为RP后至少8周连续2次PSA ≥ 0.2 ng/ml。

BGM被定义为手术切缘为良性前列腺组织。

结果

共有1082名男性因局部前列腺癌伴BGM接受RP治疗,249例(23%)标本中存在BGM。

年轻、双侧神经保留手术和机器人入路与BGM相关,而手术边缘恶性肿瘤(MSM)不相关。在RP术后7年,29%的患者检测到PSA, 11%的患者有BCR。

在达到可检测PSA的男性亚组中,79%的人在7年内有进展。在多变量Cox比例风险回归分析中,BGM状态与可检测PSA、BCR和/或从可检测PSA进展到BCR或挽救性治疗无关。

结论

RP术后残余的良性腺体组织与PSABCR相关

 

文献来源

Greenberg SA, Washington SL 3rd, Lonergan P, et al. Residual Benign Prostate Glandular Tissue after Radical Prostatectomy is Not Associated with the Development of Detectable Postoperative Serum Prostate Specific Antigen. J Urol. 2021 Sep;206(3):706-714. doi: 10.1097/JU.0000000000001793. Epub 2021 Apr 27. PMID: 33905262.

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    2021-09-17 jeanqiuqiu
  4. [GetPortalCommentsPageByObjectIdResponse(id=1877477, encodeId=4dba18e747729, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Wed Aug 24 11:35:42 CST 2022, time=2022-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1384599, encodeId=27c0138459965, content=<a href='/topic/show?id=06e068891d4' target=_blank style='color:#2F92EE;'>#生化复发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68891, encryptionId=06e068891d4, topicName=生化复发)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0bed488, createdName=jktdtl, createdTime=Fri Sep 17 00:35:42 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1586256, encodeId=f342158625603, content=<a href='/topic/show?id=38f8622191b' target=_blank style='color:#2F92EE;'>#根治#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62219, encryptionId=38f8622191b, topicName=根治)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=26d917348678, createdName=jeanqiuqiu, createdTime=Fri Sep 17 00:35:42 CST 2021, time=2021-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1051785, encodeId=f9401051e85a5, content=这个活动即可以领略到各科的新知识新动向,又可以参加抽奖,学习中伴随着抽奖有趣, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee662910810, createdName=刘明国, createdTime=Thu Sep 16 06:57:00 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1051473, encodeId=243d10514e3bb, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=735f1618587, createdName=dawins, createdTime=Wed Sep 15 12:56:32 CST 2021, time=2021-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1052687, encodeId=cd37105268e22, content=前列腺癌相关研究,学习了,谢谢梅斯, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=misszhang, createdTime=Wed Sep 15 12:35:42 CST 2021, time=2021-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1051430, encodeId=bb7110514305b, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201216/68f4e17f5f0d4e63b75a46ee82ccb663/e66b098c773645458f11c1deb93e0f2f.jpg, createdBy=5d7e5155892, createdName=146a7291m, createdTime=Wed Sep 15 10:22:10 CST 2021, time=2021-09-15, status=1, ipAttribution=)]
    2021-09-16 刘明国

    这个活动即可以领略到各科的新知识新动向,又可以参加抽奖,学习中伴随着抽奖有趣

    0

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    2021-09-15 dawins

    学习

    0

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    2021-09-15 misszhang

    前列腺癌相关研究,学习了,谢谢梅斯

    0

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    2021-09-15 146a7291m

    学习

    0

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