Analysis Of High Risk Factors And Prognostic Prediction Model Of Biochemical Recurrence After Laparoscopic Radical Prostatectomy Based On Neoadjuvant Endocrine Therapy

Objective: To explore the risk factors of biochemical recurrence after laparoscopic radical prostatectomy based on neoadjuvant endocrine therapy and to establish a prognostic prediction model for laparoscopic radical prostatectomy based on neoadjuvant endocrine therapy,so as to provide reference for the prevention of biochemical recurrence after radical prostatectomy.Materials and Methods: The clinical data of 40 patients who underwent laparoscopic radical prostatectomy after neoadjuvant endocrine therapy in the Department of Urology of our Hospital from September 1,2016 to September 1,2019 were retrospectively analyzed.The patient’s age,preoperative PSA value,preoperative and postoperative Gleason score,pathological stage,clinical stage,seminal vesicle invasion,positive surgical margin,lymph node metastasis and so on were recorded.According to the 2019 Chinese Guidelines for the Diagnosis of urological diseases,PSA≥0.2ng/ml for two consecutive times after radical prostatectomy was considered as the diagnostic criteria for biochemical recurrence.The included patients were divided into recurrence group and non-recurrence group.Cox regression model was used for multivariate analysis to identify independent risk factors.The K-M curve was used to describe the biochemical recurrence free survival after radical prostatectomy.The Nomogram was drawn by Rstudio software,and the calibration curve was drawn by resampling method for internal verification.The decision curve analysis was used to evaluate the effective clinical predictive value.Results:(1)There was no correlation between the mean age and BMI of prostate cancer patients and their biochemical recurrence after surgery(P>0.05).The preoperative PSA level,Gleason rating score before operation,Gleason rating score after operation,clinical stage(T3 stage),stage with high tumor degree(T3,T4),proportion of seminal vesicle invasion,proportion of lymph node metastasis,and proportion of patients with positive resection margin in biochemical recurrence group were all higher than those in non-recurrence group(P<0.05).(2)Univariate and multivariate Cox results showed that PSA level before surgery,Gleason score before and after surgery,TNM stage,stage of tumor pathology,invasion of seminal vesicles in peripheral organs,positive rate of resection margin and lymph node metastasis were all independent risk factors for postoperative biochemical recurrence(P<0.05).Preoperative PSA level >20ng/ml,preoperative Gleason score >7,postoperative Gleason score >7,clinical stage T3,pathological stage T3～T4,seminal vesicle invasion,lymph node metastasis,and positive resection margin were all closely related to the shortening of biochemical relapse-free survival of prostate cancer patients after laparoscopic radical surgery(P<0.05)).(3)Independent predictors in Cox’s factor analysis were used to record the specific age of prostate cancer patients,the level of PSA before and after surgery,the score of Gleason rating before and after surgery,the TNM stage,the stage of tumor pathology,the invasion of seminal vesicles in peripheral organs,the positive rate of resection margin,and the metastasis of lymph nodes.As a basis,R software was used to draw a Nomogram to predict survival without biochemical recurrence within 3 years after radical resection of prostate cancer by neoadjuvant endocrine therapy.The C index of the Nomogram was0.795,and the 95%CI interval was 0.733～8.459.It indicates that the consistency and simulation degree between predicted risk and actual risk are good.(4)The maximum Yoden index of ROC curve of the prediction model can be 0.755,and the prediction probability value is 64.50%,which is the limit,or the optimal sensitivity and specificity can be obtained,which are 86.90% at 83.20% level respectively.DCA curves show that Nomogram evaluation can bring higher clinical benefits for the determination of postoperative biochemical recurrence sites in patients with prostate cancer under neoadjuvant endocrine therapy under a certain risk threshold.Conclusions:(1)PSA level before and after surgery,Gleason rating score before and after surgery,TNM stage,stage of tumor pathology,invasion of seminal vesicles in peripheral organs,positive rate of resection margin and lymph node metastasis were all independent risk factors for postoperative biochemical recurrence of prostate cancer.(2)This Nomogram model has a good ability to predict postoperative biochemical recurrence,and can effectively evaluate the prognosis of patients,providing certain reference for the prediction of biochemical recurrence of patients with laparoscopic prostate cancer after radical surgery based on neoadjuvant endocrine therapy.