腹腔镜前列腺癌根治术后神经侵犯阳性的影响因素分析

Influencing factors for positive perineural invasion after laparoscopic radical prostatectomy

摘要:

目的 分析腹腔镜前列腺癌根治术后病理标本神经侵犯阳性的影响因素。方法 回顾2018年1月至2023年3月于川北医学院附属医院泌尿外科行腹腔镜前列腺癌根治术的104例患者临床资料，收集患者年龄、吸烟史、饮酒史、术前总前列腺特异性抗原（total prostate-specific antigen，TPSA）、术前游离前列腺特异性抗原（free prostate-specific antigen，FPSA）/总前列腺特异性抗原比值（F/T比值）、术后病理Gleason评分、包膜侵犯情况、神经侵犯情况、切缘情况、精囊侵犯情况、病理T分期，根据术后病理结果分为神经侵犯阳性组和神经侵犯阴性组。比较2组患者的年龄、吸烟史、饮酒史、术前TPSA、术前F/T比值、术后病理Gleason评分、包膜侵犯情况、切缘情况、精囊侵犯情况、病理T分期，采用卡方检验和多因素logistic回归分析分别对变量进行分析，探寻神经侵犯阳性的影响因素。结果 本研究总共纳入104例患者，其中神经侵犯阳性患者30例，约占28.85%，神经侵犯阴性患者74例，约占71.15%。所有患者术后病理结果均证实为前列腺癌。单因素分析结果显示，患者年龄、F/T比值、Gleason评分、包膜侵犯、切缘阳性、精囊侵犯、病理T分期比较差异有统计学意义（P<0.05）。吸烟史、饮酒史、术前TPSA比较差异无统计学意义（P>0.05）。将具有统计学意义的指标纳入多因素logistic回归分析，结果显示年龄<70岁和切缘阳性是腹腔镜前列腺癌根治术后神经侵犯阳性的独立影响因素（P<0.05）。结论 年龄、F/T比值、Gleason评分、包膜侵犯、切缘阳性、精囊侵犯、病理T分期与腹腔镜前列腺癌根治术后神经侵犯阳性存在显著相关。其中，年龄<70岁和切缘阳性是腹腔镜前列腺癌根治术后神经侵犯阳性的独立危险因素。

Abstract:

Objective To analyze the influencing factors for positive perineural invasion in pathological specimens after laparoscopic radical prostatectomy.Methods The clinical data of 104 patients who underwent laparoscopic radical prostatectomy in the Department of Urology of the Affiliated Hospital of North Sichuan Medical College from January 2018 to March 2023 were retrospectively analyzed. The patient’s age，smoking history，drinking history，preoperative total prostate-specific antigen（TPSA），ratio of preoperative free prostate-specific antigen/TPSA（F/T ratio），postoperative pathological Gleason score，capsular invasion，perineural invasion，resection margin，seminal vesicle invasion，and pathological T stage were collected. According to the postoperative pathological results，the patients were divided into two groups： positive perineural invasion group and negative perineural invasion group. The age，smoking history，drinking history，preoperative TPSA，preoperative F/T ratio，postoperative pathological Gleason score，capsular invasion，resection margin，seminal vesicle invasion，and pathological T stage were compared between the two groups. The chi-square test and multivariate logistic regression analysis were used to analyze the variables to explore the influencing factors for positive perineural invasion.Results A total of 104 patients were included in this study，including 30 patients with positive perineural invasion（28.85%） and 74 patients with negative perineural invasion（71.15%）. All patients were confirmed to have prostate cancer by postoperative pathological results. Univariate analysis showed that there were significant differences in age，F/T ratio，Gleason score，capsular invasion，positive resection margin，seminal vesicle invasion，and pathological T stage（P<0.05），and that there were no significant differences in smoking history，drinking history，and preoperative TPSA（P>0.05）. The statistically significant indices were included in multivariate logistic regression analysis，and the results showed that age <70 years and positive resection margin were independent influencing factors for positive perineural invasion after laparoscopic radical prostatectomy（P<0.05）.Conclusion Age，F/T ratio，Gleason score，capsular invasion，positive resection margin，seminal vesicle invasion，and pathological T stage are significantly related to positive perineural invasion after laparoscopic radical prostatectomy. Among them，age <70 years and positive resection margin are independent risk factors for positive perineural invasion after laparoscopic radical prostatectomy.