显著升级影响三分之一被诊断为前列腺癌的男性：预测列线图及内部验证。

Significant upgrading affects a third of men diagnosed with prostate cancer: predictive nomogram and internal validation.

作者信息

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

机构信息

Department of Urology, University of Hamburg, Hamburg, Germany.

出版信息

BJU Int. 2006 Aug;98(2):329-34. doi: 10.1111/j.1464-410X.2006.06262.x.

DOI:10.1111/j.1464-410X.2006.06262.x

PMID:16879673

Abstract

OBJECTIVE

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.

PATIENTS AND METHODS

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.

RESULTS

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%.

CONCLUSION

Our nomogram might prove highly useful when the possibility of a more aggressive Gleason variant could change the treatment options.

摘要

目的

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。

患者与方法

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。