| Research background:Prostate Cancer(PCa)is one of the most common malignant tumor of the urogenital system in the all world,the incidence of PCa was lower than those of the European and American countries,as the ageing of population and the popularity of Prostate specific antigen(PSA)as an important means of PCa screening in hospitals in our country,the incidence of PCa showed a trend of rising and it was up 489.85%from 1990 to 2013 in China.At present,Radical Prostatectomy(RP)is the main treatment for early localized and high-risk prostate cancer,and accepted neoadjuvant hormone therapy(Neoadjuvant Hormone Therapy,NHT)before radical prostatectomy of locally adanced and high-risk prostate cancer cases can obtain good operation effect.Biochemical recurrence(BCR)is an important indicator to determine the prognosis of radical prostatectomy.The incidence of biochemical recurrence is related to some high-risk factors,which has been widely reported at home and abroad,but there is still some controversy.In addition,there is still some controversy about the influence of neoadjuvant hormone therapy on the incidence of biochemical recurrence.The purpose of this study was to investigate the risk factors of biochemical recurrence after radical prostatectomy and the effect of neoadjuvant hormone therapy on the incidence of biochemical recurrence and its risk factors.Objective:This study aims to explore the high risk factors of biochemical recurrence after radical prostatectomy and the impact of neoadjuvant hormone therapy on the incidence of biochemical recurrence and its high risk factors,so as to provide certain guidance for the rational clinical selection of preoperative neoadjuvant hormone therapy,the evaluation of operation efficacy,postoperative management and prognosis.Methods:The clinical and follow-up data of 286 patients treated with Radical Prostatectomy in The First Affiliated Hospital of Zhengzhou University from March 2012 to December 2016 were retrospectively analyzed.Patients who lost follow-up and received postoperative radiotherapy or androgen deprivation therapy were excluded,the remaining 241 patients were included in the study.Clinical datas(including age,preoperative PSA,preoperative Gleason score,postoperative Gleason score,pathological staging,clinical staging,whether seminal vesicle invasion,whether positive surgical margin,whether lymph node metastasis,whether neoadjuvant hormone therapy)were recorded.Groups were divided according to the purpose of the study:1.To investigate the risk factors for biochemical recurrence:The biochemical recurrence was defined as PSA level>0.2ng/ml on two consecutive times during the follow-up period.The patients were analyzed into the recurrence group and the non-recurrence group according to whether biochemical recurrence after Radical Prostatectomy;2.To investigate the effect of neoadjuvant hormone therapy on biochemical recurrence and its risk factors:The patients were divided into NHT group and non-NHT group according to whether received neoadjuvant hormone therapy.SPSS 22.0 statistical software was used for statistical analysis of the data.the measurement data are tested by Non-parametric test(The' t' test is used when the variance homogeneity test is consistent with the normal distribution,and the 't'' test is used when the variance homogeneity test is inconsistent with the normal distribution),the counting data were tested with Chi-Square test,Univariate analysis was analysed by Logistic regression,Kaplan-Meier curves was used to plot the survival curve,and Cox regression model was performed for multivariate analysis(P<0.05 as the statistically significant difference).Results:1.Biochemical recurrence occurred in 93 of the 241 patients,the total biochemical recurrence rate was 38.6%.The preoperative PSA value was(51.06±12.18),preoperative Gleason score was(7.24±1.1 7),postoperative Gleason score was(7.63±1.21),seminal vesicle invasion rate was32.26%,resecting margin positive rate was 13.98%and lymph node metastasis rate was 23.66%in the recurrence group,were significantly higher than those of(21.10±7,36),(6.57±1.04),(6.99±1.13),12.84%,5.41%and 3.38%,in the non-recurrence group(P<0.05),the difference was statistically significant.It has no significant difference between the two groups about age(P>0.05).There were significant differences between the two groups in clinical stage and pathological stage(P<0.05).The Cox regression analysis result showed that preoperative PSA>20ng/ml(P=0.005),seminal vesicle invasion(P=0.003).positive resection margin(P=0.005),lymph node metastasis(P=0.000).and preoperative Gleason score>7(P=0.005)were all risk factors for biochemical recurrence after Radical Prostatectomy2.Among the 241 patients.120 received neoadjuvant hormone therapy and 121 did not,in NHT group and non-NHT group preoperative Gleason score were(6.72±1.06)and(6.94±1.20),(P>0.05),respectively,and postoperative Gleason score were(7.07±1.14)?(7.40±1.24)(P<0.05),the difference was statistically significant,the biochemical recurrence rates were 40.00%and 37.19%(P>0.05),the seminal vesicle invasion rate were 18.33%and 22.31%(P>0.05),the resecting margin positive rate were 10.00%and 7.44%(P>0.05),the lymph node metastasis rate 9.17%and 13.22%(P>0.05)Conclusions:1.Preoperative PSA,clinical staging,pathological staging,preoperative Gleason score,postoperative Gleason score,seminal vesicle invasion,resecting margin positive,and lymph node metastasis were all risk factors for biochemical recurrence after Radical Prostatectomy,and preoperative PSA>20ng/ml,preoperative Gleason score>7,seminal vesicle invasion,lymph node metastasis and resecting margin positive were high risk factors,there was no significant difference in age in biochemical recurrence2.There was no significant difference in preoperative Gleason score between neoadjuvant hormone therapy group and non-neoadjuvant hormone therapy group,the postoperative Gleason score of the two groups was significantly different,and the mean Gleason score of the neoadjuvant endocrine therapy group was significantly lower than that of the non-neoadjuvant endocrine therapy group,it suggest that neoadjuvant hormone therapy may improve postoperative pathological Gleason score and has no significant effect on biochemical recurrence,seminal vesicle invasion,lymph node metastasis and resecting margin positive... |
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