[利用活检结果预测前列腺癌的包膜穿孔和精囊侵犯]

[Use of biopsy results to predict capsular perforation and seminal vesicle invasion in prostate cancer].

作者信息

Li Guizhong, Yuan Yiming, Zhang Jun, Yang Xinyu, Xia Tongli, Guo Yinglu, Na Yanqun

机构信息

Institute of Urology, Peking University First Hospital, Beijing 100034, China.

出版信息

Beijing Da Xue Xue Bao Yi Xue Ban. 2003 Dec 18;35(6):581-5.

PMID:14710248

Abstract

OBJECTIVE

To determine the ability of clinical tests to predict extraprostatic cxtension and seminal vesicle invasion.

METHODS

Clinical T stage, TPSA total prostate specific antigen and pathologic features in systematic biopsy specimens were correlated with pathologic stage in 40 consecutive patients with clinically localized prostate cancer detected by systematic needle biopsies and treated with radical prostatectomy.

RESULTS

Extraprostatic extension was observed in 20 patients (50%) and seminal vesicle invasion was noted in 11(28%). Preoperative variables predictors of extraprostatic extension and seminal vesicle invasion on univariate analysis were TPSA, Gleason score, the total length of cancer, the number of positive cores, the percentage of positive cores, the maximum length of cancer in any one core in the biopsy specimen and the percentage of cancer in the biopsy set P<0.05 . In multivariate analysis, TPSA, Gleason score, the total length of cancer and the percentage of positive cores in the biopsy specimens were the only significant predictors of extraprostatic extension and seminal vesicle invasion P<0.01 . A model was constructed to predict advanced stage: the TPSA >or=11 microg x L(-1) and Gleason score/5 and percentage of positive cores in the biopsy specimen >or=27% or the total length of cancer>or=7.3 mm P<0.001 .

CONCLUSION

The combination of TPSA, the total length of cancer, Gleason score and percentage of positive cores in the biopsy specimens provides the best prediction of capsular perforation and seminal vesicle invasion. Models based on this combination of factors may be clinically useful to stratify patients for nonoperative treatment.

摘要

目的

确定临床检查预测前列腺外扩展和精囊侵犯的能力。

方法

对40例经系统针吸活检检出并接受根治性前列腺切除术的临床局限性前列腺癌患者，将临床T分期、总前列腺特异性抗原（TPSA）以及系统活检标本中的病理特征与病理分期进行关联分析。

结果

20例患者（50%）观察到前列腺外扩展，11例（28%）发现精囊侵犯。单因素分析中，术前预测前列腺外扩展和精囊侵犯的变量包括TPSA、Gleason评分、癌灶总长度、阳性核心数量、阳性核心百分比、活检标本中任一核心内癌灶的最大长度以及活检组中癌灶的百分比（P<0.05）。多因素分析中，TPSA、Gleason评分、癌灶总长度以及活检标本中阳性核心的百分比是前列腺外扩展和精囊侵犯的唯一显著预测因素（P<0.01）。构建了一个预测晚期的模型：TPSA≥11μg×L⁻¹且Gleason评分/5且活检标本中阳性核心百分比≥27%或癌灶总长度≥7.3mm（P<0.001）。