Singh Herb, Canto Eduardo I, Shariat Shahrokh F, Kadmon Dov, Miles Brian J, Wheeler Thomas M, Slawin Kevin M
Baylor Prostate Center, Scott Department of Urology, Baylor College of Medicine, Houston, Texas 77030, USA.
J Urol. 2004 Jan;171(1):204-9. doi: 10.1097/01.ju.0000100220.46419.8b.
We evaluated the contribution of 6 additional systematically obtained, laterally directed biopsy cores to traditional sextant biopsy for the prediction of final pathological findings in the radical prostatectomy specimen.
We studied 178 consecutive patients with no history of prostate biopsy in whom prostate cancer was diagnosed during an initial systematic 12 core biopsy and who subsequently underwent radical prostatectomy. Of the systematic 12 cores we compared the subset of the 6 traditional sextant cores (S6C), the set of 6 laterally directed cores (L6C) and the complete 12 core set, which included the 6 traditional sextant and the 6 laterally directed cores. Biopsy Gleason score, number of positive cores, total cancer length and percent of tumor in the biopsy sets were examined for their ability to predict extracapsular extension, total tumor volume and pathological Gleason score.
On univariable analyses the biopsy parameters of the complete 12 core set correlated more strongly with extracapsular extension and total tumor volume than the biopsy parameters of S6C or L6C. On multivariable analyses S6C and L6C were independent predictors of pathological features at prostatectomy.
The addition of 6 systematically obtained, laterally directed cores to traditional sextant biopsy improved the ability to predict pathological features at prostatectomy by a statistically and prognostically significant margin. Preoperative nomograms that use data from a full complement of 12 systematic cores, specifying sextant and laterally directed biopsy cores, should demonstrate improved performance in predicting prostatectomy pathology.
我们评估了另外6个系统获取的侧向穿刺活检组织芯对传统六分区活检在预测根治性前列腺切除标本最终病理结果方面的贡献。
我们研究了178例无前列腺活检史的连续患者，这些患者在初次系统的12针活检中被诊断为前列腺癌，随后接受了根治性前列腺切除术。在这12针系统活检组织芯中，我们比较了6个传统六分区组织芯（S6C）子集、6个侧向穿刺组织芯（L6C）集合以及完整的12针组织芯集合，后者包括6个传统六分区组织芯和6个侧向穿刺组织芯。对活检的Gleason评分、阳性组织芯数量、癌组织总长度以及活检组织芯中的肿瘤百分比进行检查，以评估它们预测包膜外侵犯、肿瘤总体积和病理Gleason评分的能力。
在单变量分析中，完整的12针组织芯集合的活检参数与包膜外侵犯和肿瘤总体积的相关性比S6C或L6C的活检参数更强。在多变量分析中，S6C和L6C是前列腺切除术后病理特征的独立预测因素。
在传统六分区活检基础上增加6个系统获取的侧向穿刺组织芯，在预测前列腺切除术后病理特征方面有显著改善，在统计学和预后方面都有重要意义。术前使用来自完整12针系统活检数据（明确六分区和侧向穿刺活检组织芯）的列线图，在预测前列腺切除病理方面应表现出更好的性能。
