Khoddami Seyed M, Shariat Shahrokh F, Lotan Yair, Saboorian Hossein, McConnell John D, Sagalowsky Arthur I, Roehrborn Claus G, Koeneman Kenneth S
Department of Urology, The University of Texas South-western Medical Center, Dallas, USA.
BJU Int. 2004 Jul;94(1):42-6. doi: 10.1111/j.1464-410X.2004.04898.x.
To examine whether Gleason score (GS) 3 + 4 and 4 + 3 cancers at radical prostatectomy behave differently and whether this behaviour is independently associated with prostate cancer outcome.
From July 1994 to December 2002 309 consecutive men who had a radical retropubic prostatectomy for clinically localized disease had final GS 7 tumours in their prostatectomy specimen. Statistical analyses, including multivariate logistic regression, were used to evaluate the association between variables, i.e. standard preoperative features, stage, PSA progression, standard pathological variables, metastasis and death.
In all, 215 patients (70%) had a final GS of 3 + 4 and 94 (30%) of 4 + 3. A final GS of 4 + 3 was associated with clinical stage T2 disease (P = 0.024), a higher biopsy GS (P < 0.001), seminal vesicle involvement (P < 0.001), positive surgical margins (P = 0.036), lymphovascular invasion (P = 0.018), metastases to regional lymph nodes (P = 0.008), higher preoperative serum prostate-specific antigen (PSA) (P = 0.042), and percentage positive biopsy cores (P = 0.006). In univariate analysis, patients with GS 4 + 3 had a significantly higher risk of biochemical progression than those with GS 3 + 4 (P = 0.002). The 5-year actuarial risk of biochemical progression was 17% and 35% for GS 3 + 4 and 4 + 3, respectively (P = 0.0016). In a standard postoperative multivariate analysis, only preoperative PSA and metastases to regional lymph nodes were associated with PSA progression (P < 0.001 and 0.002, respectively). However, patients with final GS 4 + 3 had a shorter PSA doubling time after progression than those with GS 3 + 4 (P = 0.009).
Tumours with a final GS of 4 + 3 are more aggressive than GS 3 + 4 tumours. Recognising the distinction in GS 7 between predominant 4 vs 3 scores after radical prostatectomy should improve the ability of clinicians to counsel patients. The GS 4 pattern deserves further molecular study.
探讨根治性前列腺切除术中 Gleason 评分（GS）3 + 4 和 4 + 3 的癌症行为是否不同，以及这种行为是否与前列腺癌预后独立相关。
1994 年 7 月至 2002 年 12 月，309 例因临床局限性疾病接受根治性耻骨后前列腺切除术的男性患者，其前列腺切除标本的最终 GS 为 7。采用包括多因素逻辑回归在内的统计分析方法评估变量之间的关联，即标准术前特征、分期、PSA 进展、标准病理变量、转移和死亡情况。
总共 215 例患者（70%）的最终 GS 为 3 + 4，94 例（30%）为 4 + 3。最终 GS 为 4 + 3 与临床分期 T2 疾病相关（P = 0.024）、活检 GS 较高（P < 0.001）、精囊受累（P < 0.001）、手术切缘阳性（P = 0.036）、淋巴管浸润（P = 0.018）、区域淋巴结转移（P = 0.008）、术前血清前列腺特异性抗原（PSA）较高（P = 0.042）以及活检阳性核心百分比（P = 0.006）。单因素分析中，GS 4 + 3 的患者生化进展风险显著高于 GS 3 + 4 的患者（P = 0.002）。GS 3 + 4 和 4 + 3 的 5 年生化进展精算风险分别为 17%和 35%（P = 0.0016）。在标准术后多因素分析中，仅术前 PSA 和区域淋巴结转移与 PSA 进展相关（分别为 P < 0.001 和 0.002）。然而，最终 GS 为 4 + 3 的患者进展后 PSA 倍增时间短于 GS 3 + 4 的患者（P = 0.009）。
最终 GS 为 4 + 3 的肿瘤比 GS 3 + 4 的肿瘤侵袭性更强。认识到根治性前列腺切除术后 GS 7 中主要为 4 分与 3 分的区别应能提高临床医生为患者提供咨询的能力。GS 4 模式值得进一步进行分子研究。
