Tollefson Matthew K, Leibovich Bradley C, Slezak Jeffrey M, Zincke Horst, Blute Michael L
Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.
J Urol. 2006 Feb;175(2):547-51. doi: 10.1016/S0022-5347(05)00152-7.
We determined the long-term clinical significance of primary Gleason pattern in patients with Gleason score 7 prostate cancer.
We reviewed the records of all patients who underwent bilateral pelvic lymph node dissection and radical retropubic prostatectomy for Gleason score 7 prostate cancer at our institution. All patients who underwent adjuvant hormonal or radiation therapy were excluded from analysis. Patients were monitored for biochemical failure, that is PSA progression, systemic recurrence and cancer specific survival.
We identified 1,688 patients who met admission criteria, of whom 1,256 (74.4%) had primary Gleason pattern 3 and 432 (25.6%) had primary Gleason pattern 4. Median followup was 6.9 years. At 10 years primary Gleason pattern 3 was associated with increased biochemical recurrence-free survival (48% vs 38%, p <0.001), lower systemic recurrence (8% vs 15%, p <0.001) and higher cancer specific survival (97% vs 93%, p = 0.013) for Gleason primary grades 3 and 4, respectively. All of these end points remained significant on multivariate analysis when controlling for preoperative PSA, seminal vesicle involvement, margin status, DNA ploidy and TNM staging. PSA doubling time was shorter in patients with primary Gleason pattern 4 (1.64 vs 1.01 years). Systemic recurrence and cancer specific survival were associated with a PSA doubling time of less than 1 year.
Gleason score 7 prostate cancer is a heterogeneous entity. We should continue to stratify patients according to primary Gleason pattern. Patients with Gleason score 4 + 3 prostate cancer have more aggressive disease and experience higher rates of biochemical failure, systemic recurrence and cancer specific death.
我们确定了Gleason评分7分的前列腺癌患者中主要Gleason分级模式的长期临床意义。
我们回顾了在本机构因Gleason评分7分的前列腺癌接受双侧盆腔淋巴结清扫术和耻骨后根治性前列腺切除术的所有患者的记录。所有接受辅助激素或放射治疗的患者均被排除在分析之外。对患者进行生化复发监测，即前列腺特异性抗原（PSA）进展、全身复发和癌症特异性生存情况。
我们确定了1688例符合纳入标准的患者，其中1256例（74.4%）主要Gleason分级模式为3级，432例（25.6%）主要Gleason分级模式为4级。中位随访时间为6.9年。在10年时，主要Gleason分级模式为3级的患者与Gleason主要分级为3级和4级的患者相比，生化无复发生存率更高（48%对38%，p<0.001），全身复发率更低（8%对15%，p<0.001），癌症特异性生存率更高（97%对93%，p = 0.013）。在控制术前PSA、精囊受累情况、切缘状态、DNA倍体和TNM分期进行多因素分析时，所有这些终点指标仍然具有显著性。主要Gleason分级模式为4级的患者PSA倍增时间较短（1.64年对1.01年）。全身复发和癌症特异性生存与PSA倍增时间小于1年相关。
Gleason评分7分的前列腺癌是一种异质性疾病。我们应继续根据主要Gleason分级模式对患者进行分层。Gleason评分4+3的前列腺癌患者疾病侵袭性更强，生化复发、全身复发和癌症特异性死亡发生率更高。
