Nelson Bradford A, Shappell Scott B, Chang Sam S, Wells Nancy, Farnham Scott B, Smith Joseph A, Cookson Michael S
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-2765, USA.
BJU Int. 2006 Jun;97(6):1169-72. doi: 10.1111/j.1464-410X.2006.06148.x.
Authors from the USA sought to establish the relationship between tumour volume, pathological stage and outcomes after radical prostatectomy. In a large series of patients they found that tumour volume was correlated directly with pathological stage, and that it was independently correlated with PSA recurrence. The authors suggested that tumour volume had a potential use for prognostication in patients undergoing radical prostatectomy. Two papers, one from the USA and one from Germany, advise a re-staging TUR in patients with superficial bladder cancer who are at high risk of early tumour progression. In a large series of patients they found that residual tumour after initial resection was commoner than might be expected, and that the second resection indicated the way to earlier radical treatment and a better prognosis.
To establish the relationship between tumour volume (TV), pathological stage and outcome after radical prostatectomy (RP), as TV is theoretically an important variable in prostate cancer pathology, but to date it has not been routinely reported and its independent prognostic significance is not well defined.
The study included 431 consecutive patients undergoing RP for clinically localized cancer, from January 2000 to January 2002, who had a pathological examination of totally submitted whole-mount processed RP specimens. In addition to Gleason grade, tumour stage and margin assessment by standard techniques, TV was determined by digital planimetry. The total TV or index TV, for cases with obvious discrete separate tumours, were correlated with pathological stage and prostate-specific antigen (PSA) recurrence.
The mean (range) follow-up was 25.4 (6-51) months, and the mean TV for all patients was 3.28 (0.4-38.8) mL. There was a direct correlation between TV and pathological stage (P < 0.001). The TV for organ-confined and extraprostatic disease was 2.09 and 6.02 mL, respectively (P < 0.001). In a multivariate analysis, TV was an independent predictor of PSA recurrence (P = 0.04). The mean TV for patients with PSA recurrence vs no recurrence was 6.8 and 2.6 mL, respectively (P < 0.001).
TV correlates directly with pathological stage in RP specimens; furthermore, it is independently correlated with PSA recurrence. TV has potential use for prognostication in patients undergoing RP, and may be combined with other well established clinical variables to aid in predicting outcomes.
美国的作者试图确立肿瘤体积、病理分期与根治性前列腺切除术后结果之间的关系。在一大组患者中，他们发现肿瘤体积与病理分期直接相关，且与前列腺特异抗原（PSA）复发独立相关。作者认为肿瘤体积在接受根治性前列腺切除术的患者中具有预后评估的潜在用途。两篇论文，一篇来自美国，一篇来自德国，建议对早期肿瘤进展风险高的浅表性膀胱癌患者进行再次分期经尿道切除术（TUR）。在一大组患者中，他们发现初次切除后残留肿瘤比预期的更常见，且二次切除为更早的根治性治疗及更好的预后指明了方向。
确立肿瘤体积（TV）、病理分期与根治性前列腺切除术（RP）后结果之间的关系，因为肿瘤体积理论上是前列腺癌病理学中的一个重要变量，但迄今为止尚未常规报告，其独立的预后意义也未明确界定。
该研究纳入了2000年1月至2002年1月期间连续431例因临床局限性癌症接受RP的患者，这些患者对全部提交的整块处理后的RP标本进行了病理检查。除了通过标准技术进行Gleason分级、肿瘤分期和切缘评估外，肿瘤体积通过数字平面测量法确定。对于有明显离散性独立肿瘤的病例，总肿瘤体积或指数肿瘤体积与病理分期和前列腺特异抗原（PSA）复发相关。
平均（范围）随访时间为25.4（6 - 51）个月，所有患者的平均肿瘤体积为3.28（0.4 - 38.8）mL。肿瘤体积与病理分期直接相关（P < 0.001）。局限于器官内和前列腺外疾病的肿瘤体积分别为2.09和6.02 mL（P < 0.001）。在多变量分析中，肿瘤体积是PSA复发的独立预测因素（P = 0.04）。PSA复发患者与未复发患者的平均肿瘤体积分别为6.8和2.6 mL（P < 0.001）。
肿瘤体积与RP标本中的病理分期直接相关；此外，它与PSA复发独立相关。肿瘤体积在接受RP的患者中具有预后评估的潜在用途，并且可以与其他已确立的临床变量相结合以帮助预测结果。
