Freedland Stephen J, Aronson William J, Terris Martha K, Kane Christopher J, Amling Christopher L, Dorey Frederick, Presti Joseph C
Department of Urology, University of California Los Angeles, Department of Surgery, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California 90095, USA.
J Urol. 2003 Jun;169(6):2136-41. doi: 10.1097/01.ju.0000065588.82511.06.
Recent studies have suggested that the percent of positive cores in the prostate needle biopsy is a significant predictor of outcome among men undergoing radical prostatectomy or radiation therapy for prostate cancer. We evaluate whether either percent of cores with cancer or percent of cores positive from the most and least involved side of the prostate needle biopsy was associated with a worse outcome among men treated with radical prostatectomy.
A retrospective survey of 1,094 patients from the SEARCH Database treated with radical prostatectomy at 4 different equal access medical centers in California between 1988 and 2002 was undertaken. We used multivariate analysis to examine whether total percent of prostate needle biopsy cores with cancer, percent of cores positive from each side of the prostate and other clinical variables were significant predictors of adverse pathology and time to prostate specific antigen (PSA) recurrence following radical prostatectomy.
On multivariate analysis serum PSA and percent of positive cores were significant predictors of positive surgical margins, nonorgan confined disease and seminal vesicle invasion. Percent of positive cores (p <0.001), serum PSA (p = 0.008) and biopsy Gleason score (p = 0.014) were significant independent predictors of time to biochemical recurrence. On a separate multivariate analysis that included the variables of total percent of positive cores, percent of positive cores from the most involved side of the biopsy, percent of positive cores from the least involved side of the biopsy and whether the biopsy was positive unilaterally or bilaterally, only the percent of positive cores from the most involved side of the biopsy was a significant independent predictor of PSA failure following radical prostatectomy. Percent of positive cores was used to separate patients into a low risk (less than 34%), intermediate risk (34% to 50%) and high risk (greater than 50%) groups, which provided significant preoperative risk stratification for PSA recurrence following radical prostatectomy (p <0.001). Percent of positive cores cut points were able to further risk stratify men who were at low (p = 0.001) or intermediate (p = 0.036) but not high (p = 0.674) risk for biochemical failure based on serum PSA and biopsy Gleason score.
Percent of positive cores in the prostate needle biopsy was a significant predictor of adverse pathology and biochemical failure following radical prostatectomy, and the cut points of less than 34%, 34% to 50% and greater than 50% can be used to risk stratify patients preoperatively. The finding that percent of positive cores from the most involved side of the biopsy was a stronger predictor of PSA failure than the total percent of cores involved suggests that multiple positive biopsies from a single side might be a better predictor of a larger total cancer volume and thus correlate with clinical outcome.
近期研究表明，前列腺穿刺活检中阳性芯针的百分比是接受前列腺癌根治术或放射治疗男性患者预后的重要预测指标。我们评估前列腺穿刺活检中癌芯针百分比或前列腺穿刺活检中受累最严重和最轻微一侧的阳性芯针百分比是否与接受前列腺癌根治术男性患者的较差预后相关。
对1988年至2002年间在加利福尼亚州4个不同的平等医疗中心接受前列腺癌根治术的1094例SEARCH数据库患者进行回顾性调查。我们使用多变量分析来检验前列腺穿刺活检芯针中癌的总百分比、前列腺两侧的阳性芯针百分比以及其他临床变量是否是前列腺癌根治术后不良病理和前列腺特异性抗原（PSA）复发时间的重要预测指标。
多变量分析显示，血清PSA和阳性芯针百分比是手术切缘阳性、非器官局限性疾病和精囊侵犯的重要预测指标。阳性芯针百分比（p<0.001）、血清PSA（p = 0.008）和活检Gleason评分（p = 0.014）是生化复发时间的重要独立预测指标。在一项单独的多变量分析中，纳入了阳性芯针总百分比、活检中受累最严重一侧的阳性芯针百分比、活检中受累最轻微一侧的阳性芯针百分比以及活检是单侧还是双侧阳性等变量，结果显示只有活检中受累最严重一侧的阳性芯针百分比是前列腺癌根治术后PSA失败的重要独立预测指标。阳性芯针百分比用于将患者分为低风险（低于34%）、中风险（34%至50%）和高风险（高于50%）组，这为前列腺癌根治术后的PSA复发提供了显著的术前风险分层（p<0.001）。阳性芯针百分比切点能够进一步对基于血清PSA和活检Gleason评分处于低风险（p = 0.001）或中风险（p = 0.036）但非高风险（p = 0.674）的生化失败男性患者进行风险分层。
前列腺穿刺活检中阳性芯针百分比是前列腺癌根治术后不良病理和生化失败的重要预测指标，低于34%、34%至50%和高于50%的切点可用于术前对患者进行风险分层。活检中受累最严重一侧的阳性芯针百分比比受累芯针的总百分比更能预测PSA失败，这一发现表明来自同一侧的多个阳性活检可能是更大总体癌体积的更好预测指标，因此与临床结果相关。
