前列腺导管腺癌临床特征及腺外侵犯的影响因素

doi:10.19723/j.issn.1671-167X.2025.05.021

摘要/Abstract

摘要： 目的: 探索不同病理类型前列腺癌患者根治性前列腺切除术(radical prostatectomy, RP)围术期临床及病理特征差异, 分析可能影响前列腺导管腺癌腺外侵犯的影响因素。方法: 回顾性收集2011年12月至2021年4月北京大学第三医院收治的行RP且病理明确为前列腺癌患者的临床资料, 获取其基本临床特征及术后病理结果。根据病理结果将患者分为导管腺癌组(混有导管腺癌)及单纯腺泡腺癌组, 并进行1 ∶1倾向评分匹配, 比较两组患者临床特征差异, 并对导管腺癌组腺外侵犯的相关因素进行单因素及多因素分析。结果: 共获得764例前列腺癌患者信息, 其中术后病理明确混有导管腺癌成分者62例。倾向评分匹配前两组患者基线特征中既往有糖尿病史的比例差异有统计学意义(29.5% vs. 17.7%, P=0.027), 共有61例单纯腺泡腺癌患者和导管腺癌患者成功匹配, 匹配后基线特征在两组间差异无统计学意义(P＞0.05)。对两组围术期临床及病理特征进行比较, 导管腺癌组国际泌尿病理协会(International Society of Urology Pathology, ISUP)分级(P=0.003)、pT分期(P=0.004)、腺外侵犯率(P=0.018)及脉管癌栓率(P=0.019)均明显高于单纯腺泡腺癌组。单因素分析显示, 前列腺特异性抗原(prostate-specific antigen, PSA)水平、前列腺体积、ISUP分级、精囊侵犯及神经侵犯可能是导管腺癌腺外侵犯的影响因素(P＜0.10);二元Logistic回归分析表明, 神经侵犯是前列腺导管腺癌腺外侵犯的独立影响因素(OR=11.78, 95%CI: 1.97~70.56, P=0.007)。结论: 前列腺导管腺癌比单纯腺泡腺癌预后更差, 神经侵犯是前列腺导管腺癌腺外侵犯的独立影响因素。

关键词: 前列腺肿瘤, 导管腺癌, 肿瘤浸润, 前列腺癌切除术, 危险因素

Abstract: Objective: To explore the differences in perioperative clinical and pathological characteristics of patients with different pathological types of prostate cancer undergoing radical prostatectomy, and to analyze the influencing factors that may affect the extraglandular invasion of ductal adenocarcinoma of the prostate. Methods: Retrospective collection was made of the radical prostatectomy patients who were admitted to Peking University Third Hospital from December 2011 to April 2021. The patients were screened based on inclusion criteria to obtain basic clinical features and postoperative pathological results. According to the pathological results, the patients were divided into ductal adenocarcinoma group (mixed with ductal adenocarcinoma) and acinar adenocarcinoma group, and a 1 ∶1 propensity score matching was performed to compare the differences in clinical characteristics between the two groups. Univariate and multivariate analyses of the factors related to extraglandular invasion were performed in the matched ductal adenocarcinoma groups. Results: A total of 764 patients with prostate cancer were enrolled in this study, of which 62 patients were confirmed to have ductal adenocarcinoma components by postoperative pathology. There was a statistically significant difference in the proportion of the patients with a history of diabetes in baseline characteristics between the two groups before propensity score matching (29.5% vs. 17.7%, P=0.027). A total of 61 patients with simple acinar adenocarcinoma were successfully matched with the patients with ductal adenocarcinoma, and there was no statistically significant difference in baseline characteristics between the two groups after matching (P>0.05). The comparison of perioperative clinical and pathological features showed that International Society of Urology Pathology (ISUP) grade (P=0.003), pT stage (P=0.004), extraglandular invasion rate (P=0.018) and vascular thrombus rate (P=0.019) in ductal adenocarcinoma group were significantly higher than those in simple acinous adenocarcinoma group. Univariate analysis of the influence factors of extraglandular invasion showed that prostate-specific antigen (PSA) level, prostate volume, ISUP grade, seminal vesicle invasion and perineural invasion might be the influencing factors of extraglandular invasion (P < 0.10). Binary Logistic regression analysis showed that perineural invasion was an independent factor of extraglandular invasion (OR=11.78, 95%CI: 1.97-70.56, P=0.007). Conclusion: Prostatic ductal adenocarcinoma has a worse prognosis than simple acinar adenocarcinoma. Perineural invasion is the influencing factor of extraglandular invasion of ductal adenocarcinoma.

Key words: Prostatic neoplasms, Ductal adenocarcinoma, Neoplasm invasiveness, Prostatectomy, Risk factors

中图分类号:

R737.25

杨小勇, 张帆, 马潞林, 刘承. 前列腺导管腺癌临床特征及腺外侵犯的影响因素[J]. 北京大学学报（医学版）, 2025, 57(5): 956-960.

Xiaoyong YANG, Fan ZHANG, Lulin MA, Cheng LIU. Clinical characteristics and influencing factors of extraglandular invasion of prostatic ductal adenocarcinoma[J]. Journal of Peking University (Health Sciences), 2025, 57(5): 956-960.

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参考文献 14

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Items	DAP (n=61)	PAA (n=61)	P value
Age/years, ${\bar x}$±s	69.39±6.66	68.85±7.54	0.675
BMI/(kg/m²), ${\bar x}$±s	25.13±2.94	24.98±3.17	0.783
Hypertension, n(%)	33 (54.1)	34 (55.7)	0.856
Diabetes, n(%)	18 (29.5)	17 (27.9)	0.841
History of malignancy, n(%)	2 (3.3)	1 (1.6)	0.641
History of prostatic operation, n(%)	3 (4.9)	2 (3.3)	0.641
PSA/(μg/L), M(Q₁, Q₃)	11.80 (6.18, 26.89)	10.22 (5.83, 19.51)	0.408
Prostate volume/mL, M(Q₁, Q₃)	40.00 (30.15, 52.65)	39.51 (26.36, 52.18)	0.519
ISUP grade, n(%)			0.003
1	1 (1.6)	8 (13.1)
2	7 (11.5)	18 (29.5)
3	7 (11.5)	7 (11.5)
4	16 (26.2)	13 (21.3)
5	30 (49.2)	15 (24.6)
Positive margin, n(%)	26 (42.6)	24 (39.3)	0.713
Extraglandular invasion, n(%)	40 (65.6)	27 (44.3)	0.018
Seminal vesicle invasion, n(%)	13 (21.3)	8 (13.1)	0.230
Perineural invasion, n(%)	51 (83.6)	43 (70.5)	0.085
Vascular cancer thrombus, n(%)	16 (26.2)	6 (9.8)	0.019
pT, n(%)			0.004
2	19 (31.1)	33 (54.1)
3	37 (60.7)	28 (45.9)
4	5 (8.2)	0
Surgical duration/min, M(Q₁, Q₃)	218 (185, 256)	221 (187, 251)	0.828
Blood loss/mL, M(Q₁, Q₃)	50 (50, 150)	50 (50, 175)	0.647

Items	Extraglandular invasion		P value
Items	Positive (n=40)	Negative (n=21)	P value
Age/years, ${\bar x}$±s	69.10±6.64	69.95±6.82	0.639
BMI/(kg/m²)，${\bar x}$±s	25.33±2.78	24.74±3.24	0.454
PSA/(μg/L), M (Q₁, Q₃)	15.08 (7.22, 36.64)	9.83 (4.77, 13.32)	0.054
Volume/mL, M (Q₁, Q₃)	36.95 (28.58, 47.15)	44.80 (34.10, 55.10)	0.074
ISUP, n(%)			0.017
1	1 (2.5)	0
2	2 (5.0)	5 (23.8)
3	2 (5.0)	5 (23.8)
4	12 (30.0)	4 (19.0)
5	23 (57.5)	7 (33.3)
Positive margin, n(%)	16 (40.0)	10 (47.6)	0.568
Seminal vesicle invasion, n(%)	12 (30.0)	1 (4.8)	0.024
Perineural invasion, n(%)	38 (95.0)	13 (61.9)	0.002
Vascular cancer thrombus, n(%)	13 (32.5)	3 (14.3)	0.124