不良病理结果之危险因素和预后.ppt

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(+) GS＞Biopsy … 危险因素 中危、高危 术前PSA＞10 ng/ml ≥cT2b Biopsy GS ≥8 年龄 吸烟 NCCN Guidelines. Prostate Cancer. Version I.2016 EAU Guidelines on Prostate Cancer. Version 2016 危险因素 GS 8~10, 26~31% organ-confined EAU Guidelines on Prostate Cancer. Version 2016 Eur Urol. 2015 Feb;67(2):319-25. Risk Group pN(+) Intermediate-risk, pN(+): 3.7~20.1% High-risk, pN(+): 15~40% 穿刺出现4分＞3针/某针以4分为主 pN(+): 20~45% 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 cores. 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 features Berg KD., et al. Primary Gleason pattern in biopsy Gleason score 7 is predictive of adverse histopathological features and biochemical 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 predictor 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 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;186:511–6. Boccon-Gibod, L., et al. Management of locally advanced prostate cancer: a European consensus. Int J Clin Pract, 2003. 57: 187. BJU