Joniau Steven, Hsu Chao-Yu, Lerut Evelyne, Van Baelen Anthony, Haustermans Karin, Roskams Tania, Oyen Raymond, Van Poppel Hein
Department of Urology, University Hospitals Leuven, Belgium.
Eur Urol. 2007 Feb;51(2):388-94; discussion 395-6. doi: 10.1016/j.eururo.2006.06.051. Epub 2006 Jul 14.
Partin tables are the most widely used tool to predict histopathologic stage after radical prostatectomy (RP) in organ-confined tumors. Such a predictive table in clinical T3 disease is still lacking. Our objective was to create a reference table for clinical unilateral T3a prostate cancer.
Between 1987 and 2004, 200 patients with clinical unilateral T3a disease underwent a RP and bilateral pelvic lymphadenectomy at our institution. No patient had received neoadjuvant treatment. Patients were divided into three prostate-specific antigen (PSA) subgroups (<or=10 ng/ml, >10-20 ng/ml, and >20 ng/ml) and two biopsy Gleason sum (GS) subgroups (<or=7 [3+4] and >or=7 [4+3]). These parameters were used in the table as predictors for final histopathology. Margin and nodal status were also recorded. The multinomial log-linear regression analysis was used to construct the table.
The table stratifies patients into six demarcated risk groups. In the first group, consisting of patients with PSA <or=10 and GS <or=7 (3+4), understaging was only 6% (5% pT3b and 1% pT4). The risk for understaging cT3a prostate cancer increases further with increasing PSA and GS. In the sixth group, consisting of patients with PSA >20 and GS >or=7 (4+3), understaging was as high as 68% (44% pT3b and 22% pT4). Receiver operating characteristic analyses showed good accurate predictive ability of the table for seminal vesicle involvement and adjacent structure involvement, with moderate predictive ability for extraprostatic extension only.
We present a table combining preoperative serum PSA and biopsy GS to predict histopathologic results in clinical unilateral T3a prostate cancer. The table may provide a basis for decision-making and patient counseling before treating this cancer.
Partin表是预测局限性肿瘤根治性前列腺切除术（RP）后组织病理学分期最广泛使用的工具。目前仍缺乏针对临床T3期疾病的此类预测表。我们的目的是创建一个针对临床单侧T3a前列腺癌的参考表。
1987年至2004年间，200例临床单侧T3a疾病患者在我们机构接受了RP及双侧盆腔淋巴结清扫术。无患者接受新辅助治疗。患者被分为三个前列腺特异性抗原（PSA）亚组（≤10 ng/ml、>10 - 20 ng/ml和>20 ng/ml）以及两个活检Gleason总分（GS）亚组（≤7 [3 + 4]和≥7 [4 + 3]）。这些参数在表中用作最终组织病理学的预测指标。切缘和淋巴结状态也被记录。采用多项对数线性回归分析来构建该表。
该表将患者分为六个明确的风险组。在第一组中，由PSA≤10且GS≤7（3 + 4）的患者组成，分期过低仅为6%（5%为pT3b，1%为pT4）。随着PSA和GS升高，cT3a前列腺癌分期过低的风险进一步增加。在第六组中，由PSA>20且GS≥7（4 + 3）的患者组成，分期过低高达68%（44%为pT3b，22%为pT4）。受试者操作特征分析表明，该表对精囊受累和相邻结构受累具有良好的准确预测能力，对前列腺外扩展仅具有中等预测能力。
我们提出了一个结合术前血清PSA和活检GS来预测临床单侧T3a前列腺癌组织病理学结果的表格。该表可为治疗这种癌症之前的决策制定和患者咨询提供依据。
