Ou Yen-Chuan, Chen Jung-Ta, Yang Chi-Rei, Cheng Chen-Li, Ho Hao-Chung, Kao Yu-Lin, Ko Jiunn-Liang, Hsieh Yih-Shou
Division of Urology, Department of Surgery, Taichung Veterans General Hospital, National Yang-Ming University School of Medicine, Taiwan.
Jpn J Clin Oncol. 2002 May;32(5):172-6. doi: 10.1093/jjco/hyf036.
To find a predictor for extracapsular tumor extension at radical retropubic prostatectomy (RRP) in Taiwanese patients with stage T1c prostate cancer (PC), preoperative transrectal sonoguiding prostate biopsy outcomes and clinicopathological data obtained from these patients were reviewed.
Fifty-five consecutive men who underwent radical retropubic prostatectomy for stage T1c PC were included. Preoperative sextant needle biopsies of the prostate were performed and whole-mount prostatectomy specimens were processed. The pathological end point was tumor capsular perforation extending entirely through the prostate capsule. Preoperative prostate-specific antigen (PSA), free-to-total PSA ratio, prostate volume, PSA density, Gleason score, number of positive biopsy cores, percentage cancer of sextant biopsies, percentage cancer of one lobe and percentage cancer of one core were analyzed for their ability to predict extracapsular tumor extension at RRP.
Eighteen of the 55 specimens showed evidence of tumor capsular perforation. Those with extracapsular tumor extension (ECE) had higher PSA than organ-confined disease (OCD) (18.4 vs 8.3 ng/ml, P < 0.01). The ECE had a higher PSA density than OCD (0.556 vs 0.226, P < 0.01). The percentage of cancer in biopsies, percentage cancer of one lobe and percentage cancer of one core were all higher in ECE than OCD (P < 0.05). The ECE had a higher biopsy Gleason score than OCD (5.6 vs 4.5, P < 0.01).
The four strongest predictors for extracapsular tumor extension of patients with T1c PC were PSA density >or=0.35, biopsy Gleason score >or=6, >or=20% cancer in biopsies and PSA >or=10 ng/ml.
为了找到台湾T1c期前列腺癌（PC）患者在耻骨后根治性前列腺切除术（RRP）时肿瘤包膜外侵犯的预测指标，回顾了这些患者术前经直肠超声引导下前列腺穿刺活检结果及临床病理资料。
纳入55例连续接受T1c期PC耻骨后根治性前列腺切除术的男性患者。术前进行前列腺六分区穿刺活检，并对前列腺全切标本进行处理。病理终点为肿瘤包膜穿孔并完全穿透前列腺包膜。分析术前前列腺特异性抗原（PSA）、游离PSA与总PSA比值、前列腺体积、PSA密度、Gleason评分、阳性穿刺活检针数、六分区活检癌组织百分比、一叶癌组织百分比及一针癌组织百分比预测RRP时肿瘤包膜外侵犯的能力。
55例标本中有18例显示肿瘤包膜穿孔迹象。肿瘤包膜外侵犯（ECE）患者的PSA高于局限于器官内疾病（OCD）患者（18.4 vs 8.3 ng/ml，P<0.01）。ECE患者的PSA密度高于OCD患者（0.556 vs 0.226，P<0.01）。ECE患者活检组织中的癌组织百分比、一叶癌组织百分比及一针癌组织百分比均高于OCD患者（P<0.05）。ECE患者的活检Gleason评分高于OCD患者（5.6 vs 4.5，P<0.01）。
T1c期PC患者肿瘤包膜外侵犯的四个最强预测指标为PSA密度≥0.35、活检Gleason评分≥6、活检癌组织≥20%及PSA≥10 ng/ml。
