前列腺穿刺活检Gleason评分≤7患者术后发生具有临床意义的Gleason评分升高预测因素分析
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摘要
目的:探讨经直肠前列腺穿刺活检病理Gleason评分(b GS)≤7患者术后发生具有临床意义的Gleason评分(pGS)升高的预测因素。方法:分析2010年1月至2017年12月170例前列腺癌根治手术患者的临床病理资料,分析有临床意义p GS升高患者的年龄、术前血清总前列腺特异抗原(tPSA)、游离PSA(fPSA)、fPSA/tPSA、前列腺体积、PSA密度(PSAD)、穿刺阳性针数比等指标分布特征,评价bGS=7和bGS≤6两组患者发生具有临床意义的pGS升高的可能因素。结果:170例患者pGS与bGS保持一致者95例(55. 9%),下降者11例(6. 5%),升高者64例(37. 6%),在pGS评分升高的患者中符合"具有临床意义的术后升高"55例(32. 4%),无临床意义的术后升高9例(5. 3%)。bGS=7的患者中穿刺阳性针数比(P=0. 021)与发生具有临床意义的pGS升高显著相关,bGS≤6的患者中年龄(P=0. 018)及PSAD(P=0. 033)与发生具有临床意义的pGS升高显著相关。进一步采用受试者工作特征曲线分析得出:bGS=7患者中穿刺阳性针数比> 0. 528,而bGS≤6患者中年龄> 64. 5岁,PSAD> 0. 267μg/(L·g)患者发生具有临床意义的pGS升高的可能性增加。结论:bGS=7患者的穿刺阳性针数比在有临床意义pGS升高中有预测价值,而bGS≤6患者的年龄及PSAD在具有临床意义的pGS升高有预测价值。
Objective: To investigate the prognostic factors for clinically significant increase in post-prostatectomy Gleason score( p GS) in patients with biopsy Gleason score( bGS) ≤7. Methods: This retrospective study included 170 cases of prostate cancer treated by radical prostatectomy in our hospital from January 2010 to December 2017. We analyzed the clinical and pathological data on the patients,including the age,preoperative serum tPSA,fPSA,fPSA/tPSA,prostate volume,PSA density( PSAD),and positive puncture rate of the patients with clinically significant elevation of p GS,as well as the possible factors for clinically significant pGS increase in patients with bGS = 7 and those with bGS ≤ 6. Results: The p GS was found consistent with the bGS in 95( 55. 9%) of the 170 patients,decreased in 11( 6. 5%) and increased in 64( 37. 6%). Among those with elevated p GS,55( 32. 4%) were shown with and the other 9( 5. 3%) without clinical significance. Clinically significant escalation of pGS was markedly correlated with the positive puncture rate in the patients with bGS = 7( P = 0. 021) and with the age( P = 0. 018) and PSAD( P = 0. 033) of those with bGS ≤ 6. ROC curve analysis further showed the positive puncture rate > 0. 528 in the patients with bGS = 7 and a higher risk of clinically significant p GS increase in those aged > 64. 5 years with bGS ≤ 6 and PSAD > 0. 267 μg/( L·g). Conclusion:Clinically significant elevation of p GS is correlated with the rate of positive punctures in prostate cancer patients with bGS = 7 and with age and PSAD in those with bGS ≤ 6.
Objective: To investigate the prognostic factors for clinically significant increase in post-prostatectomy Gleason score( p GS) in patients with biopsy Gleason score( bGS) ≤7. Methods: This retrospective study included 170 cases of prostate cancer treated by radical prostatectomy in our hospital from January 2010 to December 2017. We analyzed the clinical and pathological data on the patients,including the age,preoperative serum tPSA,fPSA,fPSA/tPSA,prostate volume,PSA density( PSAD),and positive puncture rate of the patients with clinically significant elevation of p GS,as well as the possible factors for clinically significant pGS increase in patients with bGS = 7 and those with bGS ≤ 6. Results: The p GS was found consistent with the bGS in 95( 55. 9%) of the 170 patients,decreased in 11( 6. 5%) and increased in 64( 37. 6%). Among those with elevated p GS,55( 32. 4%) were shown with and the other 9( 5. 3%) without clinical significance. Clinically significant escalation of pGS was markedly correlated with the positive puncture rate in the patients with bGS = 7( P = 0. 021) and with the age( P = 0. 018) and PSAD( P = 0. 033) of those with bGS ≤ 6. ROC curve analysis further showed the positive puncture rate > 0. 528 in the patients with bGS = 7 and a higher risk of clinically significant p GS increase in those aged > 64. 5 years with bGS ≤ 6 and PSAD > 0. 267 μg/( L·g). Conclusion:Clinically significant elevation of p GS is correlated with the rate of positive punctures in prostate cancer patients with bGS = 7 and with age and PSAD in those with bGS ≤ 6.
引文
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[13]Werahera PN,Sullivan K,Rosa FG,et al.Optimization of prostate cancer diagnosis by increasing the number of core biopsies based on gland volume.Int J Clin Exp Pathol,2012,5(9):892-899.
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[16]Moussa AS,Kattan MW,Berglund R,et al.A nomogram for predicting upgrading in patients with low-and intermediate-grade prostate cancer in the era of extended prostate sampling.BJU Int,2010,105(3):352-358.
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[19]Acimovic M,Dabicstankovic K,Pejcic T,et al.Preoperative Gleason score,percent of positive prostate biopsies and PSA in predicting biochemical recurrence after radical prostatectomy.J BUON,2013,18(4):954-960.
[20]Deng FM,Donin NM,Pe BR,et al.Size-adjusted quantitative Gleason score as a predictor of biochemical recurrence after radical prostatectomy.Eur Urol,2016,70(2):248-253.
[21]Aghazadeh MA,Frankel J,Belanger M,et al.National Comprehensive Cancer Network?favorable intermediate risk prostate cancer:Is active surveillance appropriate?J Urol,2018,199(5):1196-1201.
[22]左强,张帆,黄毅,等.前列腺癌根治术后病理升级的临床危险因素分析.北京大学学报(医学版),2016,48(4):603-606.
[23]张桂铭,秦晓健,韩成涛,等.根治性前列腺切除术后Gleason评分升高的危险因素分析.中华外科杂志,2015,53(7):543-546.
[24]Gokce MI,Tangal S,Hamidi N,et al.Role of neutrophil-tolymphocyte ratio in prediction of Gleason score upgrading and disease upstaging in low-risk prostate cancer patients eligible for active surveillance.Can Urol Assoc J,2016,10(11-12):E383-E387.
[25]Mir MC,Planas J,Raventos CX,et al.Is there a relationship between prostate volume and Gleason score?BJU int,2008,102(5):563-565.
[26]Gershman B,Shui IM,Stampfer M,et al.Prediagnostic circulating sex hormones are not associated with mortality for men with prostate cancer.Eur Urol,2014,65(4):683-689.
[27]Sun L,Caire AA,Robertson CN,et al.Men older than 70 years have higher risk prostate cancer and poorer survival in the early and late prostate specific antigen eras.J Urol,2009,185(2):2242-2249.
[28]Sarici H,Telli O,Yigitbasi O,et al.Predictors of Gleason score upgrading in patients with prostate biopsy Gleason score≤6.Can Urol Assoc J,2014,8(5-6):E342-E346.
[29]孙娟娟,王朝夫,张慧芝,等.前列腺癌穿刺标本与对应根治标本Gleason评分符合率的研究.中国癌症杂志,2012,22(12):929-933.
[30]Hong SK,Oh JJ,Byun SS,et al.Value of prostate-specific antigen(PSA)mass ratio in the detection of prostate cancer in men with PSA levels of≤10 ng/m L.BJU Int,2012,110(2):E81-E85.
[31]Jalloh M,Myers F,Cowan JE,et al.Racial variation in prostate cancer upgrading and upstaging among men with low-risk clinical characteristics.Eur Urol,2015,67(3):451-457.
[32]Truong M,Slezak JA,Lin CP,et al.Development and multi-institutional validation of an upgrading risk tool for Gleason 6 prostate cancer.Cancer,2013,119(22):3992-4002.
[33]李连军.2015年基于全国人口的队列研究对新的Gleason评分系统的评价.泌尿外科杂志(电子版),2016,8(1):64.
[2]Siegel RL,Miller KD,Jemal A.Cancer statistics,2016.Ca ACancer J Clin,2017,67(1):7-30.
[3]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015.CA Cancer J Clin,2016,66(2):115-132.
[4]Sauter G,Steurer S,Clauditz TS,et al.Clinical utility of quantitative Gleason grading in prostate biopsies and prostatectomy specimens.Eur Urol,2016,69(4):592-598.
[5]贤少忠,孔广起,宋波,等.超声引导下经会阴24针饱和前列腺穿刺活检与前列腺癌根治术后病理组织Gleason评分差异性的研究.哈尔滨医科大学学报,2016,50(4):328-332.
[6]King CR,Mcneal JE,Gill H,et al.Extended prostate biopsy scheme improves reliability of Gleason grading:Implications for radiotherapy patients.Int J Radiat Oncol Biol Phys,2004,59(2):386-391.
[7]吕志勇,吴志辉,吴小侯.前列腺癌根治术后病理分期、Gleason评分与术前血清PSA的相关性分析.第三军医大学学报,2012,34(1):78-80.
[8]王友林,朱磊一,姜波,等.超声引导下经直肠前列腺穿刺与前列腺癌根治术后病理组织Gleason评分差异性的研究.临床泌尿外科杂志,2015,25(7):628-630.
[9]Danneman D,Drevin L,Delahunt B,et al.Accuracy of prostate biopsies for predicting Gleason score in radical prostatectomy specimens:Nationwide trends 2000-2012.BJU Int,2017,119(1):50-56.
[10]Chung MS,Lee SH,Lee DH,et al.Is small prostate volume a predictor of Gleason score upgrading after radical prostatectomy?Yonsei Med J,2013,54(4):902-906.
[11]Nnabugwu II,Ugwumba FO,Enivwenae OA,et al.Serum total prostate-specific antigen values in men with symptomatic prostate enlargement in Nigeria:Role in clinical decision-making.Clin Intervent Aging,2015,13(10):89-93.
[12]Suer E,Gokce MI,Gulpinar O,et al.How significant is upgrade in Gleason score between prostate biopsy and radical prostatectomy pathology while discussing less invasive treatment options.Scand J Urol,2014,48(2):177-182.
[13]Werahera PN,Sullivan K,Rosa FG,et al.Optimization of prostate cancer diagnosis by increasing the number of core biopsies based on gland volume.Int J Clin Exp Pathol,2012,5(9):892-899.
[14]Jain S,Loblaw A,Vesprini D,et al.Gleason upgrading with time in a large prostate cancer active surveillance cohort.J Urol,2015,194(1):79-84.
[15]Morlacco A,Cheville JC,Rangel LJ,et al.Adverse disease features in Gleason score 3+4"Favorable Intermediate-Risk"prostate cancer:Implications for active surveillance.Eur Urol,2017,72(3):442-447.
[16]Moussa AS,Kattan MW,Berglund R,et al.A nomogram for predicting upgrading in patients with low-and intermediate-grade prostate cancer in the era of extended prostate sampling.BJU Int,2010,105(3):352-358.
[17]Iremashvili V,Manoharan M,Pelaez L,et al.Clinically significant Gleason sum upgrade:External validation and head-to-head comparison of the existing nomograms.Cancer,2012,118(2):378-385.
[18]Silberman MA,Partin AW,Veltri RW,et al.Tumor angiogenesis correlates with progression after radical prostatectomy but not with pathologic stage in Gleason sum 5 to 7 adenocarcinoma of the prostate.Cancer,2015,79(4):772-779.
[19]Acimovic M,Dabicstankovic K,Pejcic T,et al.Preoperative Gleason score,percent of positive prostate biopsies and PSA in predicting biochemical recurrence after radical prostatectomy.J BUON,2013,18(4):954-960.
[20]Deng FM,Donin NM,Pe BR,et al.Size-adjusted quantitative Gleason score as a predictor of biochemical recurrence after radical prostatectomy.Eur Urol,2016,70(2):248-253.
[21]Aghazadeh MA,Frankel J,Belanger M,et al.National Comprehensive Cancer Network?favorable intermediate risk prostate cancer:Is active surveillance appropriate?J Urol,2018,199(5):1196-1201.
[22]左强,张帆,黄毅,等.前列腺癌根治术后病理升级的临床危险因素分析.北京大学学报(医学版),2016,48(4):603-606.
[23]张桂铭,秦晓健,韩成涛,等.根治性前列腺切除术后Gleason评分升高的危险因素分析.中华外科杂志,2015,53(7):543-546.
[24]Gokce MI,Tangal S,Hamidi N,et al.Role of neutrophil-tolymphocyte ratio in prediction of Gleason score upgrading and disease upstaging in low-risk prostate cancer patients eligible for active surveillance.Can Urol Assoc J,2016,10(11-12):E383-E387.
[25]Mir MC,Planas J,Raventos CX,et al.Is there a relationship between prostate volume and Gleason score?BJU int,2008,102(5):563-565.
[26]Gershman B,Shui IM,Stampfer M,et al.Prediagnostic circulating sex hormones are not associated with mortality for men with prostate cancer.Eur Urol,2014,65(4):683-689.
[27]Sun L,Caire AA,Robertson CN,et al.Men older than 70 years have higher risk prostate cancer and poorer survival in the early and late prostate specific antigen eras.J Urol,2009,185(2):2242-2249.
[28]Sarici H,Telli O,Yigitbasi O,et al.Predictors of Gleason score upgrading in patients with prostate biopsy Gleason score≤6.Can Urol Assoc J,2014,8(5-6):E342-E346.
[29]孙娟娟,王朝夫,张慧芝,等.前列腺癌穿刺标本与对应根治标本Gleason评分符合率的研究.中国癌症杂志,2012,22(12):929-933.
[30]Hong SK,Oh JJ,Byun SS,et al.Value of prostate-specific antigen(PSA)mass ratio in the detection of prostate cancer in men with PSA levels of≤10 ng/m L.BJU Int,2012,110(2):E81-E85.
[31]Jalloh M,Myers F,Cowan JE,et al.Racial variation in prostate cancer upgrading and upstaging among men with low-risk clinical characteristics.Eur Urol,2015,67(3):451-457.
[32]Truong M,Slezak JA,Lin CP,et al.Development and multi-institutional validation of an upgrading risk tool for Gleason 6 prostate cancer.Cancer,2013,119(22):3992-4002.
[33]李连军.2015年基于全国人口的队列研究对新的Gleason评分系统的评价.泌尿外科杂志(电子版),2016,8(1):64.