1、前列腺癌根治性切除术后不良病理结果不良病理结果 切缘阳性 pT3a、pT3b pN(+)GSBiopsy 危险因素 中危、高危 术前PSA10 ng/ml cT2b Biopsy GS 8 年龄 吸烟NCCN Guidelines.Prostate Cancer.Version I.2016EAU Guidelines on Prostate Cancer.Version 2016危险因素 GS 810,2631%organ-confinedEAU Guidelines on Prostate Cancer.Version 2016Eur Urol.2015 Feb;67(2):319-25.
2、Risk Group&pN(+)Intermediate-risk,pN(+):3.720.1%High-risk,pN(+):1540%穿刺出现4分3针/某针以4分为主 pN(+):2045%Briganti,A.,et al.Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection:the essential importance of percentage of positive core
3、s.Eur Urol,2012.61:480.Biopsy GS 7&Adverse Pathological features 441 patients，344(3+4)vs.97(4+3)GS 4+3 worse Biopsy GS 4,cT stage,PSA,age predicted adverse pathological featuresBerg KD.,et al.Primary Gleason pattern in biopsy Gleason score 7 is predictive of adversehistopathological features and bio
4、chemical failure following radical prostatectomy.Scand J Urol.2014 Apr;48(2):168-76.Smoking 2290 patients，retrospective analysis On crude analysis,smoking was associated with positive margins(odds ratio 1.32;P=0.003)and extracapsular extension(odds ratio 1.26;P=0.036).Zapata DF.,et al.Smoking is a p
5、redictor of adverse pathological features at radical prostatectomy:Results from the Shared Equal Access Regional Cancer Hospital database.Int J Urol.2015 Jul;22(7):658-62.手术切缘阳性的危险因素 cT3 手术难度大 BMI 前列腺体积过大 手术经验不足(并非手术方式)Ofer Yossepowitch.,et al.Positive Surgical Margins After Radical Prostatectomy:A
6、Systematic Review and Contemporary Update Eur Urol,2013.Patel VR,Coelho RF,Rocco B,et al.Positive surgical margins after robotic assisted radical prostatectomy:a multi-institutional study.J Urol 2011;186:5116.Boccon-Gibod,L.,et al.Management of locally advanced prostate cancer:a European consensus.I
7、nt J Clin Pract,2003.57:187.BJU Int.2015 Jul;116(1):102-8.Germany,N=1751,417 in cT1,842 in cT2,and 492 cT3,mean(SD)follow-up was 104(28.4)m,PSM 12.2%-19.5%-38.2%预后 生化复发 局部复发：pT3、PSM 5y局部复发率高达50%EAU Guidelines on Prostate Cancer.Version 2016PSM&预后Surgical margin is an independent risk factor for BCR
8、1.7-fold increased risk of death 预后与肿瘤分期晚相关 PSM not an independent risk factor for CRPC,metastasis,or PCSM.Ofer Yossepowitch.,et al.Positive Surgical Margins After Radical Prostatectomy:A Systematic Review and Contemporary Update Eur Urol,2013.Mithal P,et al.Positive surgical margins in radical pros
9、tatectomy patients do not predictlong-term oncological outcomes:results from the Shared Equal Access RegionalCancer Hospital(SEARCH)cohort.BJU Int.2016 FebpN1&预后CSS:5y-8495%10y-5186%15y-45%33%术后出现转移灶OS:5y-7985%10y-3669%15y-42%EAU Guidelines on Prostate Cancer.Version 2016 842 patients,biopsy GS 810
10、Predictors of unfavorable outcome:PSA 10 ng/mL,cT2b,GS 9 or 10,biopsy cores high,over 50%core involvement Pierorazio PM,Ross AE,Lin BM,et al.Preoperative characteristics of high-Gleason disease predictive of favourable pathological and clinical outcomes at radical prostatectomy.BJU Int 2012;110:1122-1128.NCCN Guidelines Version 1.2016 Prostate Cancerwithwithout10y BFS4%31%10y DSS52%75%
