Analysis Of Risk Factors For Biochemical Recurrence After Laparoscopic Radical Prostatectomy

Objective:By retrospectively analyzing the preoperative and postoperative clinical data of patients who underwent laparoscopic radical prostatectomy(LRP)and exploring the risk factors of biochemical recurrence(BCR)to Provide clinical Reference comments for Follow-up and management after surgery.Material and Methods:We collected the clinical data of patients who underwent LRP In our hospital from June 2013 to April 2018,excluding cases of preoperative and postoperative adjuvant therapy,lymph node and distant metastasis and incomplete patient follow-up data,and all patients with pathologic stage ≤p T3.Among these patients,a total of 74 eligible subjects were included in this study.Age ranged from 56 to 76 years old,median age was 68 years old,30 cases < 65,and 44 cases ≥65.preoperative PSA and postoperative Gleason scores were divided into groups according to the D’amico stratification criteria for prostate cancer.There were 19 cases with PSA < 10ng/ml,23 cases with PSA 10~20ng/ml,and 32 cases with PSA≥20ng/ml.There were 18 cases,35 cases and 21 cases for Gleason scores6,7 and ≥8.Pathological stages ≤ p T2 b in 24 cases,p T2 c in 21 cases,andp T3 in 29 cases;The ratio of tumor to prostate volume in postoperative pathology was divided into groups with consecutive values,29 cases <30%,20 cases with 30% ~ 60% and 25 cases ≥60%;There were no perineural invasion in 27 cases and perineural invasion in 47 cases.There were 48 negative margin and 26 Positive surgical margin.The follow-up mainly depended on telephone and outpatient service.BCR was defined as two consecutive PSA ≥0.2ng/ml after surgery.Each patient was followed up until postoperative biochemical recurrence or until the end of follow-up.According to BCR outcome,these patients were divided into the recurrence group and non-recurrence group.And univariate and multivariate analysis of the two groups’ age,preoperative PSA,margin status,the ratio of tumor to prostate volume,Gleason score,pathological stage and perineural invasion were performed using Cox proportional hazards regression mode,the significant factor in univariate analysis were moved into multivariate analysis,and then analyze the statistic by SPSS24.0 statistical software which refers that P<0.05 was considered statistically significant.Results:Among the 74 patients,within a follow-up time of 8-66 months and a median follow-up time of 24 months,there are 24 cases of BCR,50 cases of no BCR,and biochemical recurrence rate was 32.4%.Univariate analyses: preoperative PSA(P=0.001),margin status(P<0.001),tumor proportion(P<0.001),pathological stage(P<0.001)and postoperative Gleason score(P<0.001)were statistically significant and suggested that these factors were certainly correlated with BCR after LRP.BCR was not correlated with age(P=0.900)and perineural invasion(P=0.136).Multivariate analyses outcome: margin status(P=0.0110,HR=3.426),preoperative PSA(P=0.045,HR=2.215),tumor ratio(P=0.009,HR=2.357)and postoperative Gleason score(P=0.007,HR=2.513)were independent risk factors for BCR after LRP.Conclusions1.Age and perineural invasion were not correlated with BCR.2.Pathological stage was a risk factor for BCR after LRP,however,positive surgical margin,preoperative PSA,the ratio of tumor to prostate volume and postoperative Gleason score were independent risk factors of BCR.