Freedland Stephen J, Csathy George S, Dorey Frederick, Aronson William J
Departments of Urology and Biostatistics, UCLA School of Medicine, Los Angeles 90095-1738, USA.
J Urol. 2002 Feb;167(2 Pt 1):516-20. doi: 10.1016/S0022-5347(01)69076-1.
Biopsy Gleason score, serum prostate specific antigen (PSA) levels, and clinical stage are known to be independent predictors of adverse pathological features and biochemical failure after radical prostatectomy. We determine whether various prostate needle biopsy parameters were predictive of either adverse pathological findings or disease recurrence after radical prostatectomy.
A single pathologist reviewed the prostate needle biopsy specimens of 190 men who underwent radical prostatectomy between 1991 and 2000. Biopsy specimens were examined for Gleason score, perineural invasion, number and percent of cores with cancer, and percent of total biopsy tissue with cancer and Gleason grade 4 or 5 cancer. Multivariate analysis was used to determine the prostate needle biopsy parameters and preoperative clinical variables, including serum PSA, clinical stage, patient age and race, that were most significant for predicting positive surgical margins, nonorgan confined disease, seminal vesicle invasion and biochemical failure after radical prostatectomy.
Of the prostate needle biopsy parameters examined percent of tissue with cancer was the strongest predictor of biochemical recurrence in the multivariate analysis (p <0.001). Percent of tissue with cancer was a stronger predictor of biochemical recurrence than either PSA (p = 0.048) or biopsy Gleason score (p = 0.053). It was also a strong independent predictor of seminal vesicle invasion (p = 0.015) and nonorgan confined disease (p = 0.024). Perineural invasion, percent and number of cores with cancer, and percent of tissue with Gleason grade 4 or 5 were not independent predictors of either adverse pathology or biochemical failure.
Of all the preoperative variables examined, including the standard clinical variables of serum PSA, Gleason score and clinical stage, percent of biopsy tissue with cancer was the strongest predictor of biochemical recurrence, seminal vesicle invasion and nonorgan confined disease. Consideration should be given to reporting percent of total biopsy tissue with cancer in all prostate biopsy results.
活检Gleason评分、血清前列腺特异性抗原（PSA）水平和临床分期是根治性前列腺切除术后不良病理特征和生化复发的已知独立预测因素。我们确定各种前列腺穿刺活检参数是否能预测根治性前列腺切除术后的不良病理结果或疾病复发。
一名病理学家回顾了1991年至2000年间接受根治性前列腺切除术的190名男性的前列腺穿刺活检标本。检查活检标本的Gleason评分、神经周围浸润、癌灶数量及所占比例、活检组织中癌组织及Gleason 4或5级癌组织所占比例。采用多变量分析确定对预测根治性前列腺切除术后手术切缘阳性、非器官局限性疾病、精囊侵犯和生化复发最具意义的前列腺穿刺活检参数和术前临床变量，包括血清PSA、临床分期、患者年龄和种族。
在多变量分析中，所检查的前列腺穿刺活检参数中，癌组织所占比例是生化复发的最强预测因素（p<0.001）。癌组织所占比例比PSA（p = 0.048）或活检Gleason评分（p = 0.053）更能预测生化复发。它也是精囊侵犯（p = 0.015）和非器官局限性疾病（p = 0.024）的强大独立预测因素。神经周围浸润、癌灶数量及所占比例以及Gleason 4或5级组织所占比例不是不良病理或生化复发的独立预测因素。
在所有检查的术前变量中，包括血清PSA、Gleason评分和临床分期等标准临床变量，活检组织中癌组织所占比例是生化复发、精囊侵犯和非器官局限性疾病的最强预测因素。所有前列腺活检结果均应考虑报告活检组织中癌组织的所占比例。
