摘要目的:探讨根治性前列腺切除术后生化复发的危险因素。方法:回顾性分析2010年1月至2020年12月空军军医大学第一附属医院收治的558例根治性前列腺切除术患者的临床资料。年龄平均67.9(40~87)岁，体质指数平均24.56(15.12~35.94) kg/m 2。前列腺特异性抗原(PSA)平均41.07 ng/ml，其中<10ng/ml 48例，10~20ng/ml 98例，>20 ng/ml 412例。术前穿刺病理Gleason评分6~10分者分别为123、214、118、89、14例。临床分期≤T 2b期90例，T 2c期273例，≥T 3期195例。558例均行根治性前列腺切除术，其中528例行机器人辅助腹腔镜手术，25例行腹腔镜手术，5例行开放手术。采用Cox回归分析术后生化复发的危险因素。 结果:本组558例术后病理分期pT 2a期63例，pT 2b期32例，pT 2c期241例，≥pT 3期222例。术后共210例出现生化复发，生化复发时间平均33.3(3~127)个月。1、3、5年生化复发率分别为9.67%(54/558)、21.50%(120/558)、31.70%(177/558)。在pT 2a和pT 2b期患者中，分别有7例(11.11%)和4例(12.50%)出现生化复发。pT 2c期患者中145例(60.17%)切缘阳性，术后予雄激素剥夺治疗(ADT)；pT 2c期患者中68例(28.21%)出现生化复发，生化复发时间平均36.1(3~127)个月。≥pT 3期患者中147例存在切缘阳性、包膜外侵犯，术后予ADT+放疗，其中98例(66.67%)出现生化复发，生化复发时间平均30.6(24~98)个月；75例无切缘阳性及包膜外侵犯者，术后予ADT治疗，其中33例(44.00%)出现生化复发，生化复发时间平均32.5(21~106)个月。210例生化复发患者术后5、10年生存率分别为89.05%(187/210)、78.09%(164/210)；5、10年肿瘤特异性生存率分别为92.57%(187/202)、87.69%(171/195)。210例中死亡46例，其中31例(67.39%)死于前列腺癌，15例(32.61%)死于心脑血管疾病等。多因素Cox回归分析结果显示，患者年龄≥70岁、初始PSA>20 ng/ml、≥pT 3期、穿刺Gleason评分≥7分是生化复发的独立危险因素。 结论:根治性前列腺切除术后，根据患者病理分期和切缘情况应给予相应治疗。年龄≥70岁、初始PSA>20 ng/ml、≥pT 3期、穿刺Gleason评分≥7分是术后生化复发的独立危险因素。

abstractsObjective:To investigate the risk factors for biochemical recurrence after radical prostatectomy.Methods:The clinical data of 558 radical prostatectomy patients admitted to the First Affiliated Hospital of Air Force Military Medical University from January 2010 to December 2020 were retrospectively analyzed. The average age was 67.9 (40-87) years old, and the average body mass index was 24.56 (15.12-35.94) kg/m 2. The average PSA was 41.07 ng/ml, including 48 cases<10 ng/ml, 98 cases 10-20 ng/ml, and 412 cases>20 ng/ml. There were 123, 214, 118, 89, and 14 cases with biopsy Gleason 6-10 score, respectively. The clinical stage : 90 cases in ≤T 2b, 273 cases in T 2c, and 195 cases in ≥T 3 . 558 cases underwent radical prostatectomy, including 528 robotic-assisted laparoscopic surgery, 25 laparoscopic surgery, and 5 open-surgery. The risk factors for postoperative biochemical recurrence were analyzed by Cox regression. Results:A total of 63 patients had postoperative pathological stage pT 2a, 32 patients had pT 2b, 241 patients had pT 2c, and 222 patients had ≥pT 3. A total of 210 cases developed biochemical recurrence after surgery, and the mean time to biochemical recurrence was 33.3 (3-127) months after the radical prostatectomy. The biochemical recurrence rates at 1, 3, and 5 years were 9.7% (54/558), 21.5% (120/558), and 31.7% (177/558), respectively. Among pT 2a and pT 2b patients, 7 (11.1%) and 4 (12.5%) cases developed biochemical recurrence, respectively. Among pT 2c stage patients, 145 (60.17%) cases had positive cut margins, treated with androgen-deprivation therapy (ADT) after surgery. 68 (28.21%) cases of pT 2c stage patients had biochemical recurrence at mean 36.1 (3-106)months after the radical prostatectomy. Among ≥pT 3 patients, 147 patients with positive margins, perineural invasion, seminal vesicle invasion and positive pelvic lymph nodes were treated with postoperative androgen deprivation therapy (ADT) + radiotherapy. 98 of 147 patients (66.67%) had biochemical recurrence, and the average time to biochemical recurrence was 30.6 (24-98) months.75 patients of ≥pT 3 without positive margins, perineural invasion, seminal vesicle invasion or positive pelvic lymph nodes, were treated with postoperative ADT. 33 of them (44%) had biochemical recurrence, and the average time to biochemical recurrence was 32.5 (21-106) months. 5-and 10-year survival rates of 210 patients with biochemical recurrence were 89.05% (187/210) and 78.09% (164/210) respectively, 5- and 10-year tumor-specific survival rates were 92.57% and 87.69%, respectively. 46 of 210 cases died, of which 31 (67.39%) died from prostate cancer, and 15 cases (32.61%) died from cardiovascular and cerebrovascular diseases. Multifactorial Cox regression analysis showed that patient's age ≥70 years, initial PSA > 20ng/ml, ≥pT 3 and Gleason score ≥7 were independent risk factors for biochemical recurrence. Conclusions:After radical prostatectomy, patients were treated according to their pathological stage and surgical margins. Patients with positive margins have a higher risk of biochemical recurrence. The independent risk factors for biochemical recurrence included age ≥70 years, initial PSA > 20ng/ml, ≥pT 3 and Gleason score ≥7.