基于临床指标预测前列腺癌根治术后不良病理特征及其与生化失败的关系

doi:10.3969/j.issn.1006-7795.2026.02.006

首都医科大学学报 ›› 2026, Vol. 47 ›› Issue (2): 259-266.doi: 10.3969/j.issn.1006-7795.2026.02.006

• 肿瘤演进机制与临床防治 • 上一篇下一篇

基于临床指标预测前列腺癌根治术后不良病理特征及其与生化失败的关系

赵有权^1,2,熊天宇^1,2,谢萍^1,2,3*,牛亦农^1,2*

1.首都医科大学附属北京友谊医院泌尿外科，北京 100050; 2.北京市卫生健康委员会泌尿外科研究所，北京 100050; 3.首都医科大学基础医学院细胞生物学系，北京 100069

收稿日期:2025-10-27 修回日期:2026-01-06 出版日期:2026-04-21 发布日期:2026-04-21
通讯作者: 谢萍,牛亦农 E-mail:xiep@ccmu.edu.cn; niuyinong@mail.ccmu.edu.cn
基金资助:
国家临床重点专科建设项目（20250829），北京市临床重点专科建设项目（20240930）。

Prediction of adverse pathological features after radical prostatectomy for prostate cancer by clinical indicators and association with biochemical failure

Zhao Youquan^1,2, Xiong Tianyu^1,2, Xie Ping^1,2,3*, Niu Yinong^1,2*

1.Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; 2. Institute of Urology, Beijing Municipal Health Commission, Beijing 100050, China; 3. Department of Cell Biology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China

Received:2025-10-27 Revised:2026-01-06 Online:2026-04-21 Published:2026-04-21
Supported by:
This study was supported by National Key Clinical Specialty Development Project（20250829），Beijing Key Clinical Specialty Development Project（20240930）.

摘要/Abstract

摘要： 目的探讨前列腺癌患者行根治性前列腺切除术后不良病理特征（adverse pathological features, APF）的发生情况，分析术前临床指标对其预测价值，并探讨不良病理特征与术后生化失败的关系。方法回顾性收集2016年7月至2024年7月在首都医科大学附属北京友谊医院接受根治性前列腺切除术的患者临床资料，包括一般资料，影像资料及实验室检查、穿刺及术后病理和随访资料。根据术后病理结果判断APF情况。采用单因素及多因素Logistic回归分析筛选影响APF的独立危险因素并绘制列线图，Cox回归分析筛选影响生化失败的危险因素。结果本研究共纳入352例患者，根治性前列腺切除术术后APF发生率为66.76%（235例），其中切缘阳性174例（49.43%）、包膜侵犯102例（28.98%）、精囊侵犯51例（14.49%）。生化失败发生率为39.77%，APF组明显高于非APF组，且APF组生化复发时间更短（28.0 个月 vs未达到，P<0.001）。Logistic回归分析表明较高的体质量指数（body mass index, BMI）、前列腺特异性抗原密度（prostate specific antigen density, PSAD）水平和更高的临床分期是术后APF的独立危险因素，Cox回归分析结果提示APF（HR=1.75，95% CI: 1.13~2.72，P=0.012）及较高的国际泌尿病理学会（International Society of Urological Pathology，ISUP）分级（HR=1.50，95%CI: 1.06~2.14，P=0.023）是影响患者术后生化失败的独立危险因素。结论 APF与根治性前列腺切除术后生化失败密切相关。较高PSAD、BMI水平和临床分期可作为术前预测APF的重要指标。

关键词: 前列腺癌, 根治性前列腺切除术, 不良病理特征, 生化复发, 生化持续, 危险因素, 预后

Abstract: Objective To investigate the incidence of adverse pathological features (APF) after radical prostatectomy (RP) in prostate cancer (PCa) patients, evaluate the predictive value of preoperative clinical indicators for APF, and explore the association between APF and postoperative biochemical failure.Methods Clinical data of PCa patients who underwent RP at Beijing Friendship Hospital, Capital Medical University from July 2016 to July 2024 were retrospectively collected, including general characteristics, imaging and laboratory examinations, biopsy and postoperative pathology，and follow-up data. APF was determined based on pathological findings. Univariate and multivariate Logistic regression analyses were performed to identify independent predictors of APF and to construct a nomogram, while Cox regression analysis was used to identify predictors of biochemical failure. Results A total of 352 patients were included. The incidence of APF after RP was 66.76% (235 cases), including positive surgical margin in 174 cases (49.43%), extraprostatic extension in 102 cases (28.98%), and seminal vesicle invasion in 51 cases (14.49%). Biochemical failure occurred in 39.77% of patients. The APF group had significantly higher rates of biochemical failure，with a shorter time to biochemical recurrence (28.0 months vs not reached，P<0.001). Multivariate analysis revealed that elevated body mass index (BMI), increased prostate-specific antigen density (PSAD) and advanced clinical stage were independent predictors of APF, and Cox regression analysis showed that APF （HR=1.75，95% CI: 1.13-2.72，P=0.012） and higher International Society of Urological Pathology (ISUP) grade（HR=1.50，95%CI: 1.06-2.14，P=0.023） were independent risk factors for biochemical failure. Conclusion APF is closely associated with biochemical failure after RP. Preoperative BMI, PSAD and clinical stage can serve as valuable indicators for predicting APF.

Key words: prostate cancer, radical prostatectomy, adverse pathological features, biochemical recurrence, biochemical persistence, risk factors, prognosis

中图分类号:

赵有权, 熊天宇, 谢萍, 牛亦农. 基于临床指标预测前列腺癌根治术后不良病理特征及其与生化失败的关系[J]. 首都医科大学学报, 2026, 47(2): 259-266.

Zhao Youquan, Xiong Tianyu, Xie Ping, Niu Yinong. Prediction of adverse pathological features after radical prostatectomy for prostate cancer by clinical indicators and association with biochemical failure[J]. Journal of Capital Medical University, 2026, 47(2): 259-266.

参考文献

［1］Siegel R L, Giaquinto A N, Jemal A. Cancer statistics, 2024［J］. CA Cancer J Clin, 2024, 74(1): 12－49.
［2］Tosoian J J, Yu A, Brisbane W G. Point of view: innovation and progress for screening and management of localized prostate cancer: what an exciting time［J］. J Urol, 2024, 211(2): 317－319.
［3］Bejrananda T, Pliensiri P. Prediction of biochemical recurrence after laparoscopic radical prostatectomy［J］. BMC Urol, 2023, 23(1): 183.
［4］赵峻樑, 赵迪威, 刘洋, 等. 根治性前列腺切除术后不良病理特征患者的放疗选择［J］. 中华泌尿外科杂志, 2022, 43(7): 555－558.
［5］Nasri J, Barthe F, Parekh S, et al. Nomogram predicting adverse pathology outcome on radical prostatectomy in low-risk prostate cancer men［J］. Urology, 2022, 166: 189－195.
［6］Cornford P, Van Den Bergh R C N, Briers E, et al. EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on prostate cancer-2024 update. Part I: screening, diagnosis, and local treatment with curative intent［J］. Eur Urol, 2024, 86(2): 148－163.
［7］Ravi P, Kwak L, Devlies W, et al. Adjuvant and salvage radiotherapy after neoadjuvant therapy and radical prostatectomy for high-risk localized prostate cancer［J］. Prostate, 2024, 84(4): 342－348.
［8］Tilki D, Chen M H, Wu J, et al. Adjuvant versus early salvage radiation therapy for men at high risk for recurrence following radical prostatectomy for prostate cancer and the risk of death［J］. J Clin Oncol, 2021, 39(20): 2284－2293.
［9］Berhili S, Guerrouaz M A, Terrab F Z, et al. Immediate versus salvage postoperative radiotherapy in high-risk prostate cancer patients: a critical review［J］. Cureus, 2022, 14(8): e27678.
［10］Epstein J I, Egevad L, Amin M B, et al. The 2014 international society of urological pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system［J］. Am J Surg Pathol, 2016, 40(2): 244－252.
［11］赵强, 洪保安, 纪永鹏, 等. 局限高危前列腺癌患者根治性前列腺切除术后生化失败率及其影响因素分析［J］. 中华泌尿外科杂志, 2023, 44(3): 161－166.
［12］Axén E, Stranne J, Månsson M, et al. Biochemical recurrence after radical prostatectomy-a large, comprehensive, population-based study with long follow-up［J］. Scand J Urol, 2022, 56(4): 287－292.
［13］Shi R F, Huang D, Yan J Q, et al. phi and phiD predict adverse pathological features after radical prostatectomy for prostate cancer in Chinese population［J］. Cancer Med, 2024, 13(15): e70085.
［14］Guazzoni G, Lazzeri M, Nava L, et al. Preoperative prostate-specific antigen isoform p2PSA and its derivatives, %p2PSA and prostate health index, predict pathologic outcomes in patients undergoing radical prostatectomy for prostate cancer［J］. Eur Urol, 2012, 61(3):455－466.
［15］Zhang X Y, Zhou G Q, Sun B, et al. Impact of obesity upon prostate cancer-associated mortality: a meta-analysis of 17 cohort studies［J］. Oncol Lett, 2015, 9(3): 1307－1312.
［16］Bhindi B, Locke J, Alibhai S M H, et al. Dissecting the association between metabolic syndrome and prostate cancer risk: analysis of a large clinical cohort［J］. Eur Urol, 2015, 67(1): 64－70.
［17］Ibrahim I, Kouli O, Ilangovan S, et al. Impact of centralisation of radical prostatectomy driven by the introduction of robotic systems on positive surgical margin and biochemical recurrence in pT2 prostate cancer［J］. Cancer Med, 2025, 14(2): e70514.
［18］范欣欢, 张妍, 朱琳琳, 等. 根治性前列腺切除术后切缘阳性的病理学不良特征对生化复发的影响［J］. 中华男科学杂志, 2025, 31(3): 202－207.
［19］Suh J, Jeong I G, Jeon H G, et al. Bilateral seminal vesicle invasion as a strong prognostic indicator in T3b prostate cancer patients following radical prostatectomy: a comprehensive, multicenter, long-term follow-up study［J］. Cancer Res Treat, 2024, 56(3): 885－892.
［20］Siddiqui S A, Boorjian S A, Blute M L, et al. Impact of adjuvant androgen deprivation therapy after radical prostatectomy on the survival of patients with pathological T3b prostate cancer［J］. BJU Int, 2011, 107(3): 383－388.
［21］Devos G, Tosco L, Baldewijns M, et al. ARNEO: A randomized phase II trial of neoadjuvant Degarelix with or without apalutamide prior to radical prostatectomy for high-risk prostate cancer［J］. Eur Urol, 2023, 83(6): 508－518.
［22］Yi Z L, Li H H, Li M Y, et al. Androgen deprivation therapy, neoadjuvant androgen deprivation therapy, and adjuvant androgen deprivation therapy in patients with locally advanced prostate cancer: a multi-center real-world retrospective study［J］. World J Urol, 2024, 42(1): 581.

[1]	尚雅欣, 赵有权, 熊天宇, 牛亦农, 谢萍. 人工智能在泌尿系统肿瘤诊断中的应用[J]. 首都医科大学学报, 2026, 47(2): 224-229.
[2]	熊天宇, 赵有权, 谢萍, 牛亦农. 基于病理特征的前列腺癌根治术后生化复发预测模型[J]. 首都医科大学学报, 2026, 47(2): 267-274.
[3]	吕苏展, 邹凡, 张镱山, 王明东, 全勇俊, 平浩. PILRB通过影响CCL2及CCL5细胞因子分泌促进前列腺癌进展的作用与机制研究[J]. 首都医科大学学报, 2026, 47(2): 326-337.
[4]	李晓静, 申义, 杜扬帆, 姚明言, 杨卫, 董松, 柳洪宙. 列线图预测老年人空腹血糖受损的发病风险[J]. 首都医科大学学报, 2026, 47(2): 353-359.
[5]	宋菁华, 张坤, 郭红燕, 丁慧静. 227例腹壁子宫内膜异位症临床特征分析[J]. 首都医科大学学报, 2026, 47(2): 366-374.
[6]	田雪, 夏雪, 周全, 杨味滋, 郝允逸, 孙悦, 王安心, 张彤. 症状性颅内外动脉粥样硬化性狭窄卒中复发的危险因素分析与高危人群识别[J]. 首都医科大学学报, 2026, 47(1): 43-53.
[7]	范若英, 郑曼琪, 张倩, 郭婧, 王安心, 夏雪, 李静, 许佳明. 航天职业人群心脑血管疾病10年发病风险预测模型的构建与验证[J]. 首都医科大学学报, 2026, 47(1): 70-81.
[8]	韩文莉, 邹丽颖, 郑薇, 赵越. 孕早期血红蛋白水平与妊娠期糖尿病发生的关系研究[J]. 首都医科大学学报, 2026, 47(1): 82-86.
[9]	马也娉, 刘小菁, 王小琪, 李忠心. 血钾变异性与维持性血液透析患者长期预后的相关性[J]. 首都医科大学学报, 2026, 47(1): 157-162.
[10]	国家卫生健康委加强脑卒中防治工作减少百万新发残疾工程专家委员会, 吉训明. 《2024年中国脑卒中防治报告》概要[J]. 首都医科大学学报, 2025, 46(6): 947-960.
[11]	陈璐, 江雪, 郭新颖, 刘建, 郭彩霞. 急性心肌梗死并发心包积液的危险因素及预后影响[J]. 首都医科大学学报, 2025, 46(6): 1033-1043.
[12]	吴箴言, 江雪, 郭新颖, 张洁, 刘建, 郭彩霞. 急性ST段抬高型心肌梗死患者炎性因子水平与不良心血管事件发生的关系[J]. 首都医科大学学报, 2025, 46(6): 1055-1064.
[13]	李鑫, 姜文剑, 韩杰, 张宏家. 二尖瓣修复术治疗风湿性二尖瓣病变患者的临床效果及影响患者预后的因素[J]. 首都医科大学学报, 2025, 46(5): 885-891.
[14]	杨舒悦, 刘思凡, 冀旭, 赵梦冉, 张政, 李鹏. 无镇静胃镜检查后不良反应的危险因素分析[J]. 首都医科大学学报, 2025, 46(4): 676-681.
[15]	张潇文, 唐涛, 李迪, 李深, 席春江. 急性前循环大血管闭塞性脑梗死进展速度的影响因素分析[J]. 首都医科大学学报, 2025, 46(4): 688-693.

基于临床指标预测前列腺癌根治术后不良病理特征及其与生化失败的关系

Prediction of adverse pathological features after radical prostatectomy for prostate cancer by clinical indicators and association with biochemical failure

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价