老年前列腺癌腹腔镜手术效果及术后生化复发的影响因素

Efficacy of laparoscopic surgery for elderly patients with prostate cancer and influencing factors of biochemical recurrence

【摘要】目的 评估不同腹腔镜手术入路方式在治疗老年前列腺癌中的应用效果,并分析患者术后生化复发的影响因素。方法 收集2019年1月至2021年6月遂宁市中心医院行腹腔镜下前列腺癌根治术治疗的164例前列腺癌老年患者的临床资料,其中88例行膀胱前入路治疗(前入路组),76例行膀胱后入路治疗(后入路组)。比较两组围术期指标、并发症及术后生化复发情况。采用SPSS 24.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ²检验。采用Log Rank法检验未生化复发生存时间,采用logistic回归分析评估前列腺癌老年患者腹腔镜下前列腺癌根治术后生化复发的影响因素。结果 前入路组手术时间、留置尿管时间及住院时间均低于后入路组(P＜0.05)。两组并发症总发生率、未生化复发生存时间比较,差异无统计学意义(P＞0.05)。logistic回归分析显示,术前前列腺特异性抗原≥10.0μg/L(OR=2.924,95%CI 1.753~4.877)、术后Gleason评分＞7分(OR=3.068,95%CI 1.852~5.081)、手术切缘阳性(OR=2.547,95%CI 1.417~4.578)均为腹腔镜下前列腺癌根治术后生化复发的危险因素(P＜0.05)。结论 膀胱前入路腹腔镜下前列腺癌根治术可缩短手术时间,有利于前列腺癌老年患者术后恢复；术前高PSA水平、术后高Gleason评分及手术切缘阳性患者更易发生生化复发,临床应密切监测。

基金项目:四川省卫生健康委员会科研课题(20PJ284)

【Abstract】Objective To evaluate the application efficay of different approaches of laparoscopic surgery in the treatment of prostate cancer (PCa) in the elderly and analyze the influencing factors for postoperative biochemical recurrence. Methods Clinical data of 164 elderly PCa patients undergoing laparoscopic radical prostatectomy in our hospital from January 2019 to June 2021 were collected, and 88 cases of them received bladder anterior approach treatment (anterior approach group) and 76 cases with bladder posterior approach (posterior approach group). Perioperative indicators, complications and postoperative biochemical recurrence were compared between two groups. SPSS statistics 24.0 was used for statistical analysis. Data comparison between two groups was performed using student′s t test or Chi-square test depending on data type. Log Rank test was applied to analyze the survival time of non-biochemical recurrence. Logistic regression analysis was conducted to identify the influencing factors for biochemical recurrence after laparoscopic radical prostatectomy in elderly PCa patients. Results The operation time, duration of urinary catheter retention and length of hospital stay were significantly shorter in the anterior approach group than the posterior approach group (P<0.05). There were no statistical differences in the total incidence rate of complications and the survival time of non-biochemical recurrence between two groups (P>0.05). Logistic regression analysis showed that preoperative prostate specific antigen (PSA) ≥10.0 μg/L (OR=2.924,95%CI 1.753-4.877), postoperative Gleason score >7 points (OR=3.068,95%CI 1.852-5.081) and positive surgical margin (OR=2.547, 95%CI 1.417-4.578) were risk factors of biochemical recurrence after laparoscopic radical prostatectomy (P＜0.05). Conclusion Bladder anterior approach in laparoscopic radical prostatectomy is more conducive to postoperative recovery and has shorter surgical time for elderly PCa patients. The patients with high preoperative PSA level, high postoperative Gleason score and positive surgical margin are more prone to biochemical recurrence, and should be closely monitored in clinical practice.

This work was supported by the Scientific Research Project of Sichuan Provincial Health Commission (20PJ284).