Song Cheryn, Ro Jae Y, Lee Moo-Song, Hong Sung-Joon, Chung Byung-Ha, Choi Han Yong, Lee Sang-Eun, Lee Eunsik, Kim Choung-Soo, Ahn Hanjong
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Urology. 2006 Oct;68(4):820-4. doi: 10.1016/j.urology.2006.04.029.
To investigate the clinical and pathologic characteristics of prostate cancer in Korean men to determine how ethnic differences affect clinical outcome.
The clinical and pathologic data of 604 Korean men who underwent radical prostatectomy from 1994 to 2003 were reviewed. Biochemical failure was defined as a prostate-specific antigen (PSA) level of 0.2 ng/mL or greater on two consecutive occasions after having achieved an undetectable PSA level. Patient distribution with respect to the clinical and pathologic parameters and biochemical failure rates were compared with those of contemporary Western series.
The mean preoperative PSA level was 9.9 ng/mL (range 0.4 to 38.8) and the median biopsy Gleason score was 7. The Gleason score was 7 in 186 patients (30.8%) and greater than 7 in 169 (28.0%). Gleason scores stratified with respect to clinical stage and PSA range revealed the proportion of patients with high Gleason scores (7 or greater) to be more than 50% of each subgroup throughout the clinical stages and PSA ranges. At a median follow-up of 57.9 months (range 22 to 131), biochemical failure occurred in 24.2% of all patients and in 14.3% of those with an initial serum PSA level of 10.0 ng/mL or lower. On multivariate Cox regression analysis, the Gleason score showed the strongest statistical significance for biochemical failure (P = 0.001, hazard ratio 1.376, 95% confidence interval 1.056 to 1.792) for patients with a serum PSA level of 10.0 ng/mL or lower.
A significant proportion of prostate cancers arising in Korean men exhibit poor differentiation, regardless of the initial serum PSA level or clinical stage at presentation, and adversely affect prognosis, causing a greater rate of PSA failure.
研究韩国男性前列腺癌的临床和病理特征，以确定种族差异如何影响临床结局。
回顾了1994年至2003年接受根治性前列腺切除术的604例韩国男性的临床和病理数据。生化失败定义为在前列腺特异性抗原（PSA）水平降至不可检测后，连续两次测得的PSA水平达到0.2 ng/mL或更高。将患者在临床和病理参数以及生化失败率方面的分布情况与当代西方系列研究的结果进行比较。
术前平均PSA水平为9.9 ng/mL（范围0.4至38.8），活检Gleason评分中位数为7。186例患者（30.8%）的Gleason评分为7，169例患者（28.0%）的Gleason评分大于7。根据临床分期和PSA范围分层的Gleason评分显示，在整个临床分期和PSA范围内，高Gleason评分（7或更高）患者的比例在每个亚组中均超过50%。中位随访57.9个月（范围22至131），所有患者中24.2%发生生化失败，初始血清PSA水平为10.0 ng/mL或更低的患者中14.3%发生生化失败。在多变量Cox回归分析中，对于血清PSA水平为10.0 ng/mL或更低的患者，Gleason评分对生化失败显示出最强的统计学意义（P = 0.001，风险比1.376，95%置信区间1.056至1.792）。
韩国男性中相当一部分前列腺癌表现出分化不良，无论初始血清PSA水平或就诊时的临床分期如何，均对预后产生不利影响，导致PSA失败率更高。
