복강경하 근치적 전립선적출술 후 종양학적 성적과 절제 변연 양성의 위치에 따른 종양학적 성적의 차이: 첨부 절제 변연과 첨부외 절제 변연 양성 간의 비교
Oncologic Outcome following Laparoscopic Radical Prostatectomy and the Difference in Oncologic Outcomes according to the Site of the Positive Margin: Comparison of the Apical Positive Margin with the Non-Apical Positive Margin
하유신, 김성인, 김수진, 조혁진, 홍성후, 이지열, 김준철, 김세웅, 황태곤,
소속 상세정보
하유신 ( Ha U-Syn )
가톨릭대학교 의과대학 비뇨기과학교실
김성인 ( Kim Sung-In )
가톨릭대학교 의과대학 비뇨기과학교실
김수진 ( Kim Su-Jin )
가톨릭대학교 의과대학 비뇨기과학교실
조혁진 ( Cho Hyuk-Jin )
가톨릭대학교 의과대학 비뇨기과학교실
홍성후 ( Hong Sung-Hoo )
가톨릭대학교 의과대학 비뇨기과학교실
이지열 ( Lee Ji-Youl )
가톨릭대학교 의과대학 비뇨기과학교실
김준철 ( Kim Joon-Chul )
가톨릭대학교 의과대학 비뇨기과학교실
김세웅 ( Kim Sae-Woong )
가톨릭대학교 의과대학 비뇨기과학교실
황태곤 ( Hwang Tae-Kon )
가톨릭대학교 의과대학 비뇨기과학교실
KMID : 0358320090500100955
Abstract
Purpose: The aim of this study was to analyze oncologic outcomes based on 7 years of consecutive experience with laparoscopic radical prostatectomy (LRP) and to assess the prognostic difference between an apical positive margin and a non-apical positive margin.
Materials and Methods: We reviewed 202 patients who underwent LRP between July 2001 and July 2007 (pathologic stage: T2-T3b, without any adjunctive therapy). Biochemical recurrence (bR) was defined as two consecutive prostate-specific antigen (PSA) values greater than 0.2 ng/ml. We analyzed the differences in bR among the negative margin group (N), the apical positive margin group (A), and the non-apical positive margin group (NA) and factors predicting bR.
Results: Overall 3-year probability of bR-free survival (bRFS) was 78% (pT2, 83.7%; pT3, 60.9%). For low-, intermediate-, and high-risk cancer, 3-year bRFS was 94.7%, 82.8%, and 60.7%, respectively. Of the 155 men who had negative and single-site positive margins, the numbers in the N, A, and NA groups were 108, 19, and 28, respectively. bR rates for the N, A, and NA groups were 14.8%, 36.8%, and 46.4%, respectively. Kaplan-Meier curves showed that a positive surgical margin had a significant higher bR compared with the N group; however, the A group experienced a similar bRFS compared with the NA group (p=0.613). Multivariate Cox proportional hazards analysis indicated no significant difference of effect on time to bR between the A and NA groups (hazard ratio=1.213; 95% confidence interval: 0.482-3.052).
Conclusions: Our results were almost identical to previous reports of radical prostatectomy in pT2 disease. With increasing experience, we could expect improved oncologic outcomes. In comparison with the NA group, the A group did not show a significant prognostic difference.
키워드
Prostatectomy;Recurrence;Laparoscopy
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