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Прогноз статуса хирургического края после радикальной позадилонной простатэктомии на основании данных биопсии простаты

Полный текст:


Postoperative progression of prostatic cancer (PC) after radical prostatectomy (RPE) may be caused by a residual tumor that is suggested by the presence of tumor cells in the resection positive surgical edge (PSE), regional and distant metastases.

Objective. To reveal the preoperative prognostic factors of PSE occurrence during retropubic RPE in patients with clinically localized PC. Subjects and methods. The incidence of PSE was analyzed in 288 PC patients treated with retropubic RPE between November 1997 and May 2006. The correlation between the results of transrectal multifocal prostatic biopsy and the incidence of PSE was assessed.

Results. PSE was detected in 87 (30.2%) of the 288 patients. Single and multiple PSEs were found in 70 (80.5%) and 17 (19.5%) patients, respectively. The commonest site of PSE was the posterolateral prostate surface [n = 26 (37.1%)]. In males who had less than 30.0% positive biopsies, PSE was diagnosed in 10.4% of cases. With the positive columns exceeding 30.0%, it was revealed in 52.5% of cases. In patients with PSE, the mean maximum tumor amount in the biopsy specimen was 84.8% (84.8±5.2%). PSE was detected in 71.1% of the patients with a Gleason grade of 7 or more, whereas in patients with lower grades, it was found in 19.9%. In the groups of patients with positive and negative surgical edges, perineural invasion was identified in 63 (73.3%) and 12 (5.9%) cases, respectively. In patients with PSE, the signs of capsular tumor invasion were detected in 58 (67.4%) cases and in those without PSE it was present in 20 (9.95%) cases only.

Conclusion. The incidence of PSE during retropubic RPE was associated with a number of positive columns of over 30.0%, the tumor amount in the biopsy specimen of more than 80.0%, a Gleason grade of 7 or more, capsular and perineural invasion.

Об авторах

С. Б. Петров
Кафедра урологии Военно-медицинской академии

С. А. Ракул
Кафедра урологии Военно-медицинской академии

Р. В. Новиков
Кафедра урологии Военно-медицинской академии

Р. А. Елоев
Кафедра урологии Военно-медицинской академии

Список литературы

1. Cheng L.D., Darson M.F., Bergstralh E.J. et al. Correlation of margin status and extraprostatic extension with progression of prostate carcinoma. Cancer 1999;86(9):1775—82.

2. Swindle P., Eastham J.A., Ohori M. et al. Do margins matter? The prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol 2005;174(3):903—7.

3. Wieder J.A., Soloway M.S. Incidence, etiology, location, prevention and treatment of positive surgical margin after radical prostatectomy. J Urol 1998;160(1):299—315.

4. Djuvan B., Rocco B., Ravery V. et al. European study on radical prostatectomy (ESPRE) - part I: surgicals and oncological results and changes 1993-2004. Eur Urol 2006;5(Suppl 2):129 (abstr 426).

5. Велиев Е.И., Петров С.Б., Лоран О.Б. Частота и локализация позитивного хирургического края и его роль в прогнозировании рецидива рака предстательной железы. Урология 2004;(6):19—21.

6. Петров С.Б., Ракул С.А. Положительный хирургический край при радикальной позадилонной простатэктомии: частота, прогностические факторы, медикаментозная профилактика. Онкоурология 2006;(1):40—4.

7. Epstein J.I. Evaluation of radical prostatectomy capsular margins of resection. The significance of margins designated as negative, closely approaching, and positive. Am J Surg Pathol 1990;14(7):626—32.

8. Mazzucchelli R., Santinelli A., Lopez-Beltran A. et al. Evaluation of prognostic factors in radical prostatectomy specimens with cancer. Urol Int 2002;68(4):209—15.

9. Ojea C.A., Gonzalez P.A., Dominguez F.F. Prognostic implications of positive margins in radical prostatectomy specimens. Actas Urol Esp 2005;29(7):641—7.

10. Ackerman D.A., Barry J.M., Wicklund R.A. et al. Analysis of risk factors associated with prostate cancer extension to the surgical margin and pelvic node metastasis at radical prostatectomy. J Urol 1993;150(6):1845—50.

11. Eastham J.A., Kattan M.W., Riedel E. et al. Variations among individual surgions in the rate of positive surgical margins in radical prostatectomy specimens. J Urol 2003;170(4):2292—5.

12. Walsh P.C., Donker P.J. Impotance following radical prostatectomy: insight into etiology and prevention. J Urol 1982;128(2):492—7.

13. Weldon V.E., Tavel F.R., Neuwirth H. et al. Patterns of positive specimen margins and detectable prostate specific antigen after radical perineal prostatectomy. J Urol 1995;153(5):1565—9.

14. Shuford M.D., Cookson M.S., Chang S.S. et al. Adverse prognostic significance of capsular incision with radical retropubic prostatectomy. J Urol 2004;172(1):119—23.

15. Ohori M., Wheeler T.M., Kattan M.W. et al. Prognostic significance of positive surgical margins in radical prostatectomy specimens. J Urol 1995;154(5):1818—24.

16. Pettus J.A., Weight C.J., Thompson C.J. et al. Biochemical failure in men following radical retropubic prostatectomy: impact of surgical margin status and location. J Urol 2004;171(1):129—32.

17. Sofer M., Hamilton-Nelson K.L., Cavintos F. et al. Positive surgical margins after radical retropubic prostatectomy: the influence of site and number on progression. J Urol 2002;167(6):2453—6.

18. Paulson D.F. Impact of radical prostatectomy in the management of clinically localized disease. J Urol 1994;152(5 Pt 2):1826—30.

19. Paulson D.F. Radical perineal prostatectomy: a 20 year experience. J Urol 1997;157(Pt 2):92 (abstr 358).

20. True L.D. Surgical pathology examination of the prostate gland. Practice Survey by American Society of Clinical Pathologists. Am J Clin Pathol 1994;102(5):572—9.

21. D'Amico A.V., Whittington R., Malkowicz S.B. et al. An analysis of the time course of postoperative prostate-specific antigen failure in patients with positive surgical margins: implications on the use of adjuvant therapy. Urology 1996;47(4):538—47.

22. Ozkan F. Correlation of perineural invasion on radical retropubic specimens with other pathologic prognostic factors ands PSA failure. Eur Urol 2001;40(2):308—12.

23. Villers A., McNeal J.E., Redwine E. et al. The role of perineural space invasion in the local spread of prostatic carcinoma. J Urol 1989;142(3):742—68.

24. Aus G., Abbou C.C., Bolla M. et al. EAU guidelines on prostate cancer. Eur Urol 2005;48 (Suppl 4):546Р51.

Для цитирования:

Петров С.Б., Ракул С.А., Новиков Р.В., Елоев Р.А. Прогноз статуса хирургического края после радикальной позадилонной простатэктомии на основании данных биопсии простаты. Онкоурология. 2007;3(2):51-55.

For citation:

Petrov S.B., Rakul S.A., Novikov R.V., Yeloyev R.A. Prediction of the status of a surgical edge after radical retropubic prostatectomy on the basis of prostatic biopsy data. Cancer Urology. 2007;3(2):51-55. (In Russ.)

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