| Objective:1. To collecte all the clinical data of prostate cancer patients with radical prostatectomy.2. To analyze the clinical data of patients and establish preoperative pathological upgrade prediction model and analyze the possible factors relate to positive surgery margin.3. Postoperative follow-up including: the recovery of postoperative patients' continence, biochemical recurrence, postoperative quality of life. Method:1. We collected the clinical data of 264 patients with radical prostatectomy in our department from August 2008 to December 2013. Clinical data include:age, prostate specific antigen(PSA), prostate specific antigen density(PSAD), PSA ratio, volume of prostate and biopsy Gleason score, clinical stage, danger level, operation time, blood transfusion volume, surgical margin statu, lymph gland statu, postoperative pathology Gleason score.Use statistical methods to analyze patients' data whose postoperative pathological score exceed than preoperative biopsy Gleason score and establisied preoperative pathological upgrade prediction model, then analyzed the possible factors relate to positive surgery margin.2. Methods of follow-up: asked for details of postoperative patients' urinary continence recovery with telephone, inspection information of postoperative patients obtained from clinic inspection system, deliver the quality of life survey scales to patients. Using cox multiple factors analysis methods to analyze factors associated with urinary continence and biochemical recurrence, Kaplan Meier Curving Method to curve plotting of urine continence and biochemical recurrence, the Log- rank test to compare the factors between the different groups. Result:1?collection of the preoperative clinical data:In 264 patients, data missed in 11 cases, 7 cases accepted preoperative endocrine therapy, 7 cases accepted Transurethral Resection Of Prostate(TURP), 1 case was diagnosed of spindle cell sarcoma.2?The analysis of the preoperative clinical data:(1) By multi-factor analysis we found that prostate specific antigen density(P = 0.00) and prostate preoperative biopsy score(P = 0.00) have a significant correlation to pathology upgrade. And set up the prediction nomograph about prostate cancer postoperative pathological upgrading.(2) By multi-factor analysis found that preoperative PSA(P = 0.009) and postoperative pathological Gleason score(P = 0.016) have a significant correlation to positive surgery margin.3?Results of postoperative follow-up:Of 264 patients, 29 patients lost to follow up, 197 cases of the 235 patients have recoveried urinary continence, and the remaining 38 cases did not complete recovery postoperative urinary continence. Due to the lack of clinical data of 9 cases, and finally 191 cases(84.51%) of 226 patients recovery urinary continence, 35(15.49%) cases who still have urinary incontinence were included in the statistical analysis. There are 22 patients undergo biochemical recurrence. Totally 235 follow-up letters were posted, we received 120(51.06%) reply,and the WHOQOL-BREF questionnaire deleted 14 cases, SF-36 deleted 12 cases who did not fill out completely. Finally, there were 106 WHOQOL-BREF and 108 SF-36 added to statistics.(1) By the late follow-up to collect urine continence recovery time, and Cox multiple-factors analysis did not find any obvious correlation factors to urine continence, Kaplan Meier method drawn urinary continence and biochemical recurrence curve and the Log- rank test compare various factors between different groups.(2) Cox univariate analysis showed that clinical stage(P = 0.023), D 'Amico dangerous grade(P = 0.033), postoperative pathological Gleason score(P = 0.002) have obvious correlation to biochemical recurrence of postoperative patients. Multivariate cox regression analysis showed that clinical stage(P=0.048,HR=1.858), postoperative pathological Gleason score(P=0.004,HR=1.978) have correlation to biochemical recurrence. Log-rank test showed that the P value of clinical stage and postoperative pathological Gleason score was 0.066 and 0.005 respectively.(3) The WHO scale reliability Cronbach 'alpha was 0.937, SF- 36 scale reliability Cronbach' alpha was 0.910. WHO scale factor analysis, reliability and validity of KMO was 0.888(P=0.00). SF- 36 scale factor analysis reliability and validity of KMO was 0.843(P = 0.00). WHO scale rather than SF- 36 scale is more suitable for the patient's quality of life survey after radical prostatectomy. Conclusion:Preliminary studies suggest that the prostate specific antigen density and preoperative biopsy score have significant correlation to pathological upgrade. By multi-factor analysis found that preoperative PSA value and postoperative pathological Gleason score have significant correlation to positive surgical margin. Cox multiple-factors analysis did not find any obvious correlation factors to urinary continence, Kaplan Meier method drawn urinary continence and the Log-rank test compare various factors between different groups. Cox multiple-factors analysis showed that clinical stage, postoperative pathological Gleason score have obvious correlation to biochemical recurrence of postoperative patients. Log-rank test showed that clinical stage not has a very significant correlation to biochemical recurrence,but postoperative pathological Gleason score had a significant correlation to biochemical recurrence. WHO scale rather than SF-36 scale is more suitable for the patient's quality of life survey after radical prostatectomy. |
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