Objective: The aim of this study was to test for the association between lymphovascular invasion or perineural invasion in radical prostatectomy (RP) specimens and biochemical recurrence (BCR). Methods: Relying on a tertiary-care database, we identified prostate cancer patients treated with RP between January 2014 and June 2023. Of these, the majority underwent robotic-assisted RP (81%). Kaplan–Meier survival analyses and Cox regression models addressed BCR according to either lymphovascular invasion or perineural invasion in RP specimens. Additionally, the linear trend test assessed the association between the Gleason Grade Group or pathologic tumor stage and lymphovascular or perineural invasion. Results: Of 822 patients, 78 (9%) exhibited lymphovascular invasion and 633 (77%) exhibited perineural invasion in RP specimens. In survival analyses, the five-year BCR-free survival rates were 62% in patients with lymphovascular invasion vs. 70% in patients without lymphovascular invasion (p= 0.04) and 64% in patients with perineural invasion vs. 82% in patients without perineural invasion (p= 0.01). In univariable Cox regression models, lymphovascular invasion (hazard ratio 1.58, 95% confidence interval 1.01–2.47;p= 0.045) and perineural invasion (hazard ratio 1.77, 95% confidence interval 1.13–2.77;p= 0.013) were both associated with a higher BCR rate. After accounting for age at surgery, PSA value, pathologic tumor stage, Gleason Grade Group, lymph node invasion, positive surgical margin, surgical approach, and adjuvant radiation therapy, lymphovascular (p= 0.740) or perineural invasion (p= 0.341) were not significantly associated with a higher BCR since the Gleason Grade Group and pathologic tumor stage highly correlated with lymphovascular as well as perineural invasion. Conclusions: In univariable models, lymphovascular or perineural invasion is associated with BCR. After adjustment for standard pathologic tumor characteristics, lymphovascular or perineural invasion is not an independent predictor for BCR.
目的：本研究旨在检验根治性前列腺切除术（RP）标本中淋巴血管侵犯或神经周围侵犯与生化复发（BCR）之间的关联。方法：基于一家三级医疗中心数据库，我们筛选出2014年1月至2023年6月期间接受RP治疗的前列腺癌患者。其中大多数患者接受了机器人辅助RP（81%）。通过Kaplan-Meier生存分析和Cox回归模型，根据RP标本中是否存在淋巴血管侵犯或神经周围侵犯评估BCR。此外，采用线性趋势检验评估格里森分级组或病理肿瘤分期与淋巴血管侵犯或神经周围侵犯之间的关联。结果：在822例患者中，78例（9%）RP标本显示淋巴血管侵犯，633例（77%）显示神经周围侵犯。生存分析显示，淋巴血管侵犯患者的五年无BCR生存率为62%，而无淋巴血管侵犯患者为70%（p=0.04）；神经周围侵犯患者的五年无BCR生存率为64%，而无神经周围侵犯患者为82%（p=0.01）。在单变量Cox回归模型中，淋巴血管侵犯（风险比1.58，95%置信区间1.01–2.47；p=0.045）和神经周围侵犯（风险比1.77，95%置信区间1.13–2.77；p=0.013）均与较高的BCR率相关。在调整手术年龄、PSA值、病理肿瘤分期、格里森分级组、淋巴结侵犯、手术切缘阳性、手术方式及辅助放疗后，淋巴血管侵犯（p=0.740）或神经周围侵犯（p=0.341）与较高的BCR无显著关联，因为格里森分级组和病理肿瘤分期与淋巴血管侵犯及神经周围侵犯高度相关。结论：在单变量模型中，淋巴血管侵犯或神经周围侵犯与BCR相关。但在调整标准病理肿瘤特征后，淋巴血管侵犯或神经周围侵犯并非BCR的独立预测因子。
肿瘤(癌症)患者之家