目的：回顾性分析机器人辅助根治性前列腺切除术后发生前列腺包膜外侵犯（EPE）的危险因素， 以指导治疗方案决策。方法：回顾性分析 2019 年 3 月—2022 年 12 月于湖南省人民医院行机器人辅助根治性前列腺 切除术（RARP）患者的临床资料，收集患者年龄、前列腺特异性抗原（PSA）、前列腺体积（PV）、前列腺成像 报告和数据系统（PI-RADS）、穿刺最高累及百分比、前列腺穿刺 Gleason 评分及 RARP 术后病理结果等，采用单 因素和多因素 Logistic 回归分析 RARP 术后病理包膜外侵犯的危险因素，并运用 ROC 曲线比较各危险因素的预测价 值。结果：本研究共纳入 55 例符合条件者，RARP 术后病理提示前列腺包膜外侵犯共 33 例（60%）。单因素分析 显示年龄、PI-RADS 评分、穿刺 Gleason 评分、穿刺神经侵犯、穿刺最高累及百分比与 RARP 术后发生包膜外侵犯 有显著关系（P<0.05），多因素分析显示 PSA、PI-RADS、穿刺 Gleason 评分、穿刺最高累及百分比是 RARP 术后发 生包膜外侵犯的独立危险因素（P<0.05），AUC 值分别为 0.57、0.67、0.83、0.84；PI-RADS、穿刺 Gleason 评分、 穿刺最高累及百分比三组联合时对 EPE 的预测价值最高：AUC=0.861，灵敏度 0.61，特异性 0.96。结论：PSA、PIRADS、穿刺最高累及百分比、穿刺 Gleason 评分是 RARP 术后发生 EPE 的独立危险因素，综合分析 PI-RADS、穿 刺 Gleason 评分和穿刺最高累及百分比能提高对 EPE 预测的准确性。

Objective: To retrospectively explore the risk factors of extraprostatic extension (EPE) after robot-assisted radical prostatectomy (RARP) to guide treatment decision making. Methods: Clinical data of patients who underwent RARP in Hunan Provincial People’s Hospital from March 2019 to December 2022 were collected, including patient age, prostate-specific antigen (PSA), prostate volume (PV), prostate imaging-reporting and data system (PI-RADS), tumor percentage of the highest biopsy score, Gleason score of prostate biopsy, and pathological results after radical prostatectomy. Univariate and multivariate Logistic regression analyses were conducted to identify risk factors for extraprostatic extension after RARP. Receiver operating characteristic (ROC) curve analysis was used to compare the predictive values of each risk factor. Results: A total of 55 patients were included in the study, 33 cases of EPE occurred after RARP. Univariate analysis results showed a significant relation between age, PI-RADS score, biopsy Gleason score, perineural invasion in biopsy, the tumor percentage of the highest biopsy score, and the presence of EPR after RARP(P<0.05). Multivariate analysis indicated that PSA, PI-RADS, biopsy Gleason score, and the tumor percentage of the highest biopsy score were independent risk factors for EPR after RARP. The AUC values of the above four risk factors were 0.57, 0.67, 0.83, and 0.84, respectively. The highest predictive value (AUC=0.861) for EPE was achieved when the three factors (PI-RADS, biopsy Gleason score, and tumor percentage of the highest biopsy score) combined, with a sensitivity of 0.61 and specificity of 0.96. Conclusion: The PI-RADS, PSA level, tumor percentage of the highest biopsy score, and biopsy Gleason score are independent risk factors for ECE, and comprehensive analysis of PI-RADS, biopsy Gleason score and the tumor percentage of the highest biopsy score can improve the predictive accuracy of ECE.

收稿日期：2023-07-24  录用日期：2023-12-26 

Received Date: 2023-07-24  Accepted Date: 2023-12-26 

基金项目：湖南省卫生健康委 2023 年度科研计划项目（D202304057410） 

Foundation Item: Scientific Research Project of Health Commission of Hunan Province in 2023(D202304057410) 

通讯作者：李远伟，Email: liyuanwei@hunnu.edu.cn 

Corresponding Author: LI Yuanwei, Email: liyuanwei@hunnu.edu.cn 

引用格式：曾一鸣，李远伟，李宗霖，等 . 机器人辅助根治性前列腺切除术后前列腺包膜外侵犯的预测因素分析（附手术视频）[J]. 机器人外科学杂志（中英文），2024，5（4）：516-520. 

Citation: ZENG Y M, LI Y W, LI Z L, et al. Predictive factors of extraprostatic extension after robot-assisted radical prostatectomy (with surgical video)[J]. Chinese Journal of Robotic Surgery, 2024, 5(4): 516-520.

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