Bismar Tarek A, Lewis James S, Vollmer Robin T, Humphrey Peter A
Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
Am J Surg Pathol. 2003 Apr;27(4):432-40. doi: 10.1097/00000478-200304000-00002.
The capacity of perineural invasion by carcinoma in prostate needle biopsy tissue to independently predict pathologic stage in radical prostatectomy tissues remains uncertain. We sought to determine, in a prostate specific antigen-based screening population, the ability of needle biopsy histologic grade, tumor extent, and perineural invasion to independently predict pathologic stage and margin status in the whole prostate gland. Perineural invasion, Gleason grade, percentage Gleason pattern 4/5 carcinoma, and multiple measures of needle biopsy tumor extent, including number of positive cores, percentage of positive cores, total percentage of carcinoma, greatest percentage of carcinoma in a single core, and total carcinoma length in millimeters, were captured for 215 men from a prostate specific antigen-based screening program diagnosed with prostate cancer in a median of six procured needle biopsy cores. Pathologic stage and surgical margin status were evaluated in corresponding completely embedded radical prostatectomy specimens. A logistic regression model was used to relate the endpoints of extraprostatic extension by carcinoma and/or positive margins to needle biopsy tissue findings. In univariate analyses, total percentage of carcinoma (p = 0.003), greatest percentage of carcinoma in a single core (p = 0.004), total tumor length in millimeters (p = 0.009), and fraction of positive cores (p = 0.02) were all significantly associated with extraprostatic (pT3) carcinoma, whereas all five measures of carcinoma extent in needle biopsy tissue were related to positive margins. Correlation coefficient determinations showed that all five measures of needle biopsy carcinoma extent were highly interrelated. In multivariate analyses, total percentage of carcinoma was significantly related to pathologic T stage (p = 0.003) and positive margins (p = 0.0002). In a multivariate model with the radical prostatectomy whole gland endpoint of either pT3 disease or positive margins, fraction of positive cores (p = 0.00001) was the only variable with significant predictive value. Perineural invasion by carcinoma in needle biopsy tissue was detected in 11% of cases. Neither presence nor absence of perineural carcinoma nor number nor percentage of positive nerves related to pathologic stage in univariate or multivariate analyses. Amount of carcinoma in prostate needle biopsy tissue, using multiple measurements but not perineural invasion, is a significant histologic attribute predictive of pathologic stage and margin status for men with prostate specific antigen screening detected prostatic carcinoma. Reporting of several measures of carcinoma extent in needle biopsy tissue is recommended.
前列腺穿刺活检组织中癌的神经周围浸润能力能否独立预测根治性前列腺切除组织中的病理分期仍不确定。我们试图在基于前列腺特异性抗原的筛查人群中，确定穿刺活检的组织学分级、肿瘤范围和神经周围浸润能否独立预测整个前列腺腺体的病理分期和切缘状态。从基于前列腺特异性抗原的筛查项目中选取了215名被诊断为前列腺癌的男性，他们接受了中位6针穿刺活检，记录了神经周围浸润、Gleason分级、Gleason 4/5级癌的百分比以及穿刺活检肿瘤范围的多项指标，包括阳性针芯数量、阳性针芯百分比、癌的总百分比、单个针芯中癌的最大百分比以及以毫米为单位的癌的总长度。在相应的完全包埋的根治性前列腺切除标本中评估病理分期和手术切缘状态。使用逻辑回归模型将癌的前列腺外扩展和/或阳性切缘的终点与穿刺活检组织结果相关联。在单变量分析中，癌的总百分比（p = 0.003）、单个针芯中癌的最大百分比（p = 0.004）、以毫米为单位的肿瘤总长度（p = 0.009）和阳性针芯比例（p = 0.02）均与前列腺外（pT3）癌显著相关，而穿刺活检组织中癌范围的所有五项指标均与阳性切缘相关。相关系数测定表明，穿刺活检癌范围的所有五项指标高度相关。在多变量分析中，癌的总百分比与病理T分期（p = 0.003）和阳性切缘（p = 0.0002）显著相关。在以pT3疾病或阳性切缘为根治性前列腺切除全腺体终点的多变量模型中，阳性针芯比例（p = 0.00001）是唯一具有显著预测价值的变量。在11%的病例中检测到穿刺活检组织中有癌的神经周围浸润。在单变量或多变量分析中，神经周围癌的有无、阳性神经的数量或百分比均与病理分期无关。对于前列腺特异性抗原筛查发现前列腺癌的男性，使用多项指标而非神经周围浸润来衡量前列腺穿刺活检组织中的癌量，是预测病理分期和切缘状态的重要组织学属性。建议报告穿刺活检组织中癌范围的多项指标。
