Chun Felix K-H, Briganti Alberto, Shariat Shahrokh F, Graefen Markus, Montorsi Francesco, Erbersdobler Andreas, Steuber Thomas, Salonia Andrea, Currlin Eike, Scattoni Vincenzo, Friedrich Martin G, Schlomm Thorsten, Haese Alexander, Michl Uwe, Colombo Renzo, Heinzer Hans, Valiquette Luc, Rigatti Patrizio, Roehrborn Claus G, Huland Hartwig, Karakiewicz Pierre I
Department of Urology, University of Hamburg, Hamburg, Germany.
BJU Int. 2006 Aug;98(2):329-34. doi: 10.1111/j.1464-410X.2006.06262.x.
To explore the rate of significant upgrading from biopsy to radical prostatectomy (RP) specimens in a contemporary cohort, and to develop a prognostic model capable of predicting the probability of significant upgrading, as previous reports indicate that up to 43% of men with low-grade prostate cancer at biopsy will be diagnosed with high-grade cancer at RP.
The study cohort comprised 4789 men (median age 63 years, range 39-82) treated with RP, with available clinical stage, prostate-specific antigen levels, biopsy and RP Gleason sum values. These variables were used as predictors in multivariate logistic regression models (LRMs) addressing the rate of significant Gleason sum upgrading, defined as a Gleason sum increase either from < or = 6 to > or = 7 or from 7 to > or = 8 between the biopsy and RP specimens. Regression coefficients were used to develop and validate (200 bootstrap re-samples) a nomogram predicting significant biopsy Gleason sum upgrading.
Significant biopsy Gleason sum upgrading was recorded in 1349 (28.2%) patients. In multivariate LRMs, all predictors were highly significant (all P < 0.001). The bootstrap-corrected accuracy of the nomogram predicting the probability of significant Gleason sum upgrading between biopsy and RP specimens was 75.7%.
Our nomogram might prove highly useful when the possibility of a more aggressive Gleason variant could change the treatment options.
在当代队列中探索活检标本与根治性前列腺切除术（RP）标本之间显著升级的发生率，并建立一个能够预测显著升级概率的预后模型，因为既往报告表明，活检时低级别前列腺癌患者中高达43%在RP时会被诊断为高级别癌症。
研究队列包括4789例接受RP治疗的男性（中位年龄63岁，范围39 - 82岁），有可用的临床分期、前列腺特异性抗原水平、活检及RP Gleason总分值。这些变量被用作多因素逻辑回归模型（LRMs）中的预测因子，该模型针对显著的Gleason总分升级率，定义为活检标本与RP标本之间Gleason总分从≤6增加到≥7或从7增加到≥8。回归系数用于建立并验证（200次自抽样重采样）一个预测活检Gleason总分显著升级的列线图。
1349例（28.2%）患者记录到活检Gleason总分显著升级。在多因素LRMs中，所有预测因子均具有高度显著性（所有P < 0.001）。预测活检与RP标本之间Gleason总分显著升级概率的列线图经自抽样校正后的准确率为75.7%。
当更具侵袭性的Gleason变异体的可能性可能改变治疗方案时，我们的列线图可能证明非常有用。
