Ochiai Atsushi, Troncoso Patricia, Chen Michael E, Lloreta Joseph, Babaian R Joseph
Department of Urology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA.
J Urol. 2005 Dec;174(6):2164-8, discussion 2168. doi: 10.1097/01.ju.0000181211.49267.43.
We assessed the relationship between the number of positive cores obtained at extended biopsy and tumor volume in radical prostatectomy specimens as a tool for predicting the biological significance of prostate cancer from biopsy data.
The study group included 207 men who were treated with radical prostatectomy without neoadjuvant therapy at our cancer center. All patients were diagnosed by systematic extended biopsy (10 or 11 cores) performed between 1997 and 2003. The variables analyzed were patient age, prostate specific antigen, clinical stage, biopsy Gleason score, maximum tumor length in a core, greatest percent of tumor in a core, total tumor length, total percent of tumor in all cores, positive core location, initial or repeat biopsy and prostate volume in subgroups based on the number of positive cores, that is group 1-1, group 2-2 and group 3-3 or more cores. Bivariate correlation analysis and multiple logistic regression analysis were used to determine the predictors of insignificant cancer.
The number of positive cores was significantly related to total tumor volume (r = 0.433, p <0.001). Insignificant prostate cancer (volume less than 0.5 cc and Gleason score 6 or less) was found in 21.7% of patients (45 of 207). The incidence of insignificant cancer was 42.5% (31 of 73 patients) in group 1, 16.4% (10 of 61) in group 2 and 5.5% (4 of 73) in group 3. There was a significant difference in the incidence of insignificant cancer among the subgroups (group 1 vs 2 p <0.001, group 1 vs 3 p <0.0001 and group 2 vs 3 p <0.05). The best model for predicting insignificant cancer in group 1 was the combination of tumor length less than 2 mm, Gleason score 3 + 4 or less and prostate volume greater than 50 cc with 83.9% sensitivity (26 of 31 patients) and 61.9% specificity (26 of 42).
The probability of insignificant cancer was directly related to the number of positive cores. Tumor length in a core, Gleason score and prostate volume significantly enhanced the prediction model for insignificant cancer in men with 1 positive core who underwent extended biopsy.
我们评估了在根治性前列腺切除标本中，扩大活检获得的阳性核心数量与肿瘤体积之间的关系，以此作为从活检数据预测前列腺癌生物学意义的一种工具。
研究组包括207名在我们癌症中心接受根治性前列腺切除术且未接受新辅助治疗的男性。所有患者均通过1997年至2003年间进行的系统性扩大活检（10或11个核心）进行诊断。分析的变量包括患者年龄、前列腺特异性抗原、临床分期、活检Gleason评分、核心中肿瘤的最大长度、核心中肿瘤的最大百分比、肿瘤总长度、所有核心中肿瘤的总百分比、阳性核心位置、初次或重复活检以及基于阳性核心数量的亚组中的前列腺体积，即1-1组、2-2组和3-3个或更多核心组。采用双变量相关性分析和多元逻辑回归分析来确定无意义癌症的预测因素。
阳性核心数量与肿瘤总体积显著相关（r = 0.433，p <0.001）。21.7%的患者（207例中的45例）发现无意义前列腺癌（体积小于0.5 cc且Gleason评分6或更低）。1组中无意义癌症的发生率为42.5%（73例患者中的31例），2组为16.4%（61例中的10例），3组为5.5%（73例中的4例）。亚组间无意义癌症的发生率存在显著差异（1组与2组p <0.001，1组与3组p <0.0001，2组与3组p <0.05）。预测1组中无意义癌症的最佳模型是肿瘤长度小于2 mm、Gleason评分为3 + 4或更低以及前列腺体积大于50 cc的组合，敏感性为83.9%（31例患者中的26例），特异性为61.9%（42例中的26例）。
无意义癌症的概率与阳性核心数量直接相关。核心中的肿瘤长度、Gleason评分和前列腺体积显著增强了接受扩大活检且有1个阳性核心的男性无意义癌症的预测模型。
