Ojea Calvo A, Núñez López A, Domínguez Freire F, Alonso Rodrigo A, Rodríguez Iglesias B, Benavente Delgado J, Barros Rodríguez J M, Gómez-González M C, González Piñeiro A, Otero García M, Nogueira March J L
Servicio de Urología, Complejo Hospitalario Xeral-Cies, Vigo, Pontevedra.
Actas Urol Esp. 2003 Jun;27(6):428-37. doi: 10.1016/s0210-4806(03)72949-0.
We assess the value of the percent of cancer in needle cores of sextant biopsy for predicting the risk of extraprostatic extension at radical retropublic prostatectomy.
We reviewed prostate needle biopsy findings in 97 patients with prostate cancer T1c-T2, who subsequently underwent radical retropubic prostatectomy. In each needle biopsy were assessed, number of cores positive, percent of cores positive, percent cancer in all cores, Gleason score, intraepithelial neoplasia, perineural invasion and vascular invasion. Initial PSA and preoperative clinical stage were incorporated with biopsy results into a univariate and multivariate model to determine the parameters most predictive of pathological stage.
Of the 97 patients, 72 (74%) had organ confined cancer and 25 (26%) had extraprostatic extension. The average of cores positive for organ confined cancer was 4.2 (median 4) vs. 6.9 (median 6) for extraprostatic extension (p = 0.001), the percent of cores positive for organ confined cancer was 34.9% (median 28) vs. 53.8% (median 46) for extraprostatic extension (p = 0.013). The average of cancer in all cores in organ confined cancer was 13.6% (median 6) vs. 30.5% (median 30) for extraprostatic extension (p = 0.002). The mean Gleason score in needle cores was 5.9 (median 6) in organ confined cancer vs. 6.6 (median 7) in extraprostatic extension (p = 0.007). The average of intraepithelial neoplasia in needle cores was 3 (4%) in organ confined cancer vs. 1 (4%) in extraprostatic extension (p = 0.972). The perineural invasion of needle cores was 6 (8.3%) in confined cancer vs. 4 (16%) in extraprostatic extension (p = 0.355). Univariate analysis demonstrated that the risk of extraprostatic extension is predicted by the number of cores positive (p = 0.003), the percent of cores positive (p = 0.006), the percent of cancer in all cores (p = 0.001), the Gleason score (p = 0.002), the clinical stage (p = 0.019) and initial PSA (p = 0.032). Extraprostatic extension is not predicted by the intraepithelial neoplasia (p = 0.971), vascular invasion and perineural invasion (p = 0.285). Multivariate analysis showed that the percent of cancer in all cores is the strongest predictor of extraprostatic extension (p = 0.035). With a percent of cancer less than 3% in the biopsy specimen, the risk of extraprostatic extension is 11.5%.
The amount of cancer on preoperative needle sextant biopsy is the strongest predictor of prostate stage, but it is slightly practical at the moment of admitting or to reject a patient for radical prostatectomy.
我们评估六分区活检针芯中癌组织所占百分比对于预测耻骨后根治性前列腺切除术中前列腺外侵犯风险的价值。
我们回顾了97例T1c - T2期前列腺癌患者的前列腺穿刺活检结果，这些患者随后接受了耻骨后根治性前列腺切除术。对每次穿刺活检评估阳性针芯数量、阳性针芯百分比、所有针芯中癌组织所占百分比、Gleason评分、上皮内瘤变、神经周围侵犯和血管侵犯情况。将初始前列腺特异抗原（PSA）和术前临床分期与活检结果纳入单因素和多因素模型，以确定最能预测病理分期的参数。
97例患者中，72例（74%）为器官局限性癌，25例（26%）有前列腺外侵犯。器官局限性癌阳性针芯平均数为4.2（中位数4），前列腺外侵犯为6.9（中位数6）（p = 0.001）；器官局限性癌阳性针芯百分比为34.9%（中位数28），前列腺外侵犯为53.8%（中位数46）（p = 0.013）。器官局限性癌所有针芯中癌组织平均百分比为13.6%（中位数6），前列腺外侵犯为30.5%（中位数30）（p = 0.002）。针芯中Gleason评分在器官局限性癌中平均为5.9（中位数6），前列腺外侵犯中为6.6（中位数7）（p = 0.007）。针芯中上皮内瘤变平均数在器官局限性癌中为3（4%），前列腺外侵犯中为1（4%）（p = 0.972）。针芯神经周围侵犯在局限性癌中为6例（8.3%），前列腺外侵犯中为4例（16%）（p = 0.355）。单因素分析表明，前列腺外侵犯风险可由阳性针芯数量（p = 0.003）、阳性针芯百分比（p = 0.006）、所有针芯中癌组织百分比（p = 0.001）、Gleason评分（p = 0.002）、临床分期（p = 0.019）和初始PSA（p = 0.032）预测。上皮内瘤变（p = 0.971）、血管侵犯和神经周围侵犯（p = 0.285）不能预测前列腺外侵犯。多因素分析显示，所有针芯中癌组织百分比是前列腺外侵犯的最强预测因素（p = 0.035）。活检标本中癌组织百分比小于3%时，前列腺外侵犯风险为11.5%。
术前六分区穿刺活检中癌组织的量是前列腺分期的最强预测因素，但目前在决定患者是否适合接受根治性前列腺切除术时实用性稍显不足。
