低危型前列腺癌患者术前穿刺病理Gleason评分发生术后病理升级的相关因素分析
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摘要
目的:探讨引起低危型前列腺癌(PCa)患者术前穿刺病理Gleason评分发生术后病理升级的独立危险因素。方法:收集我院收治的150例低危型PCa患者的临床资料,包括年龄、体质指数、TPSA、PSAD、F/T、前列腺体积、阳性穿刺百分比和术前临床分期,比较各相关因素中术后大体病理未升级者与术后大体病理升级者之间的差异,将差异有统计学意义的变量代入多因素Logistic回归分析,找出发生术后病理升级的独立危险因素。结果:(1)术后大体病理Gleason评分较术前穿刺病理Gleason评分发生升级者55例,占36.67%。(2)前列腺体积、阳性穿刺百分比和术前临床分期等因素的术后大体病理未升级例数与术后大体病理升级例数比较差异有统计学意义(P<0.05)。(3)多因素Logistic回归分析显示,前列腺体积与阳性穿刺百分比为低危型PCa患者术后病理升级的独立危险因素(P<0.05)。结论:前列腺体积较小与穿刺阳性百分比较低可能是低危型PCa患者术后Gleason评分升高的独立危险因素。
Objective:To investigate the independent risk factors for preoperative biopsy gleason score in patients with low-risk prostate cancer upgrading after surgery.Method:The clinical data of 150 patients of low-risk prostate cancer admitted to department of urology in our hospital were collected,including age,body mass index,TPSA,PSAD,F/T,prostate volume,percentage of positive puncture and preoperative clinical stage.The difference of the factors between Gleason score upgrading and not upgrading were compared.Multivariate logistic regression analysis was used to identify independent risk factors for gleason score upgrading.Result:(1)There were55 patients whose gleason score were upgraded,accounting for 36.67%.(2)There was significant difference between the patients with gleason score upgrading and not upgrading(P<0.05),such as prostate volume,percentage of positive puncture and preoperative clinical stage.(3) Multivariate Logistic regression analysis showed that prostate volume and percentage of positive puncture were independent risk factors for Gleason score upgrading in patients with low-risk prostate cancer(P<0.05).Conclusion:The smaller prostate volume and the lower positive percentage of puncture may be the independent risk factors for gleason score upgrading in patients with low-risk prostate cancer.
Objective:To investigate the independent risk factors for preoperative biopsy gleason score in patients with low-risk prostate cancer upgrading after surgery.Method:The clinical data of 150 patients of low-risk prostate cancer admitted to department of urology in our hospital were collected,including age,body mass index,TPSA,PSAD,F/T,prostate volume,percentage of positive puncture and preoperative clinical stage.The difference of the factors between Gleason score upgrading and not upgrading were compared.Multivariate logistic regression analysis was used to identify independent risk factors for gleason score upgrading.Result:(1)There were55 patients whose gleason score were upgraded,accounting for 36.67%.(2)There was significant difference between the patients with gleason score upgrading and not upgrading(P<0.05),such as prostate volume,percentage of positive puncture and preoperative clinical stage.(3) Multivariate Logistic regression analysis showed that prostate volume and percentage of positive puncture were independent risk factors for Gleason score upgrading in patients with low-risk prostate cancer(P<0.05).Conclusion:The smaller prostate volume and the lower positive percentage of puncture may be the independent risk factors for gleason score upgrading in patients with low-risk prostate cancer.
引文
1叶定伟,朱耀.中国前列腺癌的流行病学概述和启示[J].中华外科杂志,2015,53(4):249-252.
2 Sanda M G,Cadeddu J A,Kirkby E,et al.Clinically localized prostate cancer:AUA/ASTRO/SUO guideline.Part I:risk stratification,shared decision making,and care options[J].J Urol,2017.
3 刘俊,胡卫列,宋波,等.穿刺标本Gleason评分预测前列腺癌病理分级准确性的研究[J].中国男科学杂志,2010,24(3):25-28.
4 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[J].临床泌尿外科杂志,2015,30(7):628-630.
5 Epstein J I,Allsbrook W C Jr,Amin M B,et al.Update on the Gleason grading system for prostate cancer:results of an international consensus conference of urologic pathologists[J].Adv Anat Pathol,2006,13(1):57-59.
6 Corcoran N M,Hong M K,Casey R G,et al.Upgrade in Gleason score between prostate biopsies and pathology following radical prostatectomy significantly impacts upon the risk of biochemical recurrence[J].BJU Int,2011,108(8Pt 2):E202-E210.
7 杨冰,周哲,石健,等.健康青壮年男性前列腺体积的经腹超声测定研究[J].中华临床医师杂志:电子版,2013,7(19):55-57.
8 Chun F K,Steuber T,Erbersdobler A,et al.Development and internal validation of a nomogram predicting the probability of prostate cancer gleason sum upgrading between biopsy and radical prostatectomy pathology[J].Eur Urol,2006,49(5):820-826.
9 Capitanio U,Karakiewicz P I,Valiquette L,et al.Biopsy core number represents one of foremost predictors of clinically significant gleason sum upgrading in patients with low-risk prostate cancer[J].Urology,2009,73(5):1087-1091.
10 Turley R S,Hamilton R J,Terris M K,et al.Small transrectal ultrasound volume predicts clinically significant Gleason score upgrading after radical prostatectomy:results from the SEARCH database[J].J Urol,2008,179(2):523-527.
11 赵红超,祝恒成,吕胜启,等.低血清PSA型前列腺癌的回顾性研究[J].临床泌尿外科杂志,2016,31(1):59-61.
12 Moussa A S,Kattan M W,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[J].BJU Int,2010,105(3):352-358.
13 Kassouf W,Nakanishi H,Ochiai A,et al.Effect of prostate volume on tumor grade in patients undergoing radical prostatectomy in the era of extended prostatic biopsies[J].J Urol,2007,178(1):111-114.
14 Truong M,Slezak J A,Lin C P,et al.Development and multi-institutional validation of an upgrading risk tool for Gleason 6 prostate cancer[J].Cancer,2013,119(22):3992-4002.
15 Serkin F B,Soderdahl D W,Cullen J,et al.Patient risk stratification using Gleason score concordance and upgrading among men with prostate biopsy Gleason score 6 or 7[J].Urol Oncol,2010,28(3):302-307.
2 Sanda M G,Cadeddu J A,Kirkby E,et al.Clinically localized prostate cancer:AUA/ASTRO/SUO guideline.Part I:risk stratification,shared decision making,and care options[J].J Urol,2017.
3 刘俊,胡卫列,宋波,等.穿刺标本Gleason评分预测前列腺癌病理分级准确性的研究[J].中国男科学杂志,2010,24(3):25-28.
4 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[J].临床泌尿外科杂志,2015,30(7):628-630.
5 Epstein J I,Allsbrook W C Jr,Amin M B,et al.Update on the Gleason grading system for prostate cancer:results of an international consensus conference of urologic pathologists[J].Adv Anat Pathol,2006,13(1):57-59.
6 Corcoran N M,Hong M K,Casey R G,et al.Upgrade in Gleason score between prostate biopsies and pathology following radical prostatectomy significantly impacts upon the risk of biochemical recurrence[J].BJU Int,2011,108(8Pt 2):E202-E210.
7 杨冰,周哲,石健,等.健康青壮年男性前列腺体积的经腹超声测定研究[J].中华临床医师杂志:电子版,2013,7(19):55-57.
8 Chun F K,Steuber T,Erbersdobler A,et al.Development and internal validation of a nomogram predicting the probability of prostate cancer gleason sum upgrading between biopsy and radical prostatectomy pathology[J].Eur Urol,2006,49(5):820-826.
9 Capitanio U,Karakiewicz P I,Valiquette L,et al.Biopsy core number represents one of foremost predictors of clinically significant gleason sum upgrading in patients with low-risk prostate cancer[J].Urology,2009,73(5):1087-1091.
10 Turley R S,Hamilton R J,Terris M K,et al.Small transrectal ultrasound volume predicts clinically significant Gleason score upgrading after radical prostatectomy:results from the SEARCH database[J].J Urol,2008,179(2):523-527.
11 赵红超,祝恒成,吕胜启,等.低血清PSA型前列腺癌的回顾性研究[J].临床泌尿外科杂志,2016,31(1):59-61.
12 Moussa A S,Kattan M W,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[J].BJU Int,2010,105(3):352-358.
13 Kassouf W,Nakanishi H,Ochiai A,et al.Effect of prostate volume on tumor grade in patients undergoing radical prostatectomy in the era of extended prostatic biopsies[J].J Urol,2007,178(1):111-114.
14 Truong M,Slezak J A,Lin C P,et al.Development and multi-institutional validation of an upgrading risk tool for Gleason 6 prostate cancer[J].Cancer,2013,119(22):3992-4002.
15 Serkin F B,Soderdahl D W,Cullen J,et al.Patient risk stratification using Gleason score concordance and upgrading among men with prostate biopsy Gleason score 6 or 7[J].Urol Oncol,2010,28(3):302-307.