Mohler J L, Partin A W, Epstein J I, Becker R L, Mikel U V, Sesterhenn I A, Mostofi F K, Gleason D F, Sharief Y, Coffey D S
Department of Urology, Johns Hopkins University, School of Medicine, Baltimore, Maryland.
Cancer. 1992 Jan 15;69(2):511-9. doi: 10.1002/1097-0142(19920115)69:2<511::aid-cncr2820690239>3.0.co;2-3.
Carcinoma is found unexpectedly in approximately 10% or more of the 400,000 prostatectomies performed annually in the United States. Patients with Stage A2 carcinoma die of their disease in only 35% of the cases. To alter the course of disease in these patients, 65% of Stage A2 patients may be treated unnecessarily by radical prostatectomy, radiation therapy, or hormonal therapy. An accurate method to predict the outcome of patients with Stage A2 carcinoma is needed. Histologic sections from 18 patients with Stage A2 prostatic carcinoma followed without further treatment until progression, or followed without progression, were evaluated by several investigators who did not have knowledge of patient outcomes and who employed standard pathologic grading systems as well as morphometric, cytophotometric, flow cytometric, and immunohistochemical techniques. Outcome was predicted correctly by random sampled absolute (17 of 18 cases) and relative (16 of 18) nuclear roundness factor (NRF), tumor volume expressed as percent of specimen (13 of 16), primary (13 of 18), secondary (14 of 18), sum (15 of 18), and worse (14 of 18) Gleason grades and prostate-specific antigen immunohistochemical findings (13 of 18) that produced statistically significant separation of the two groups. Significant separation was not obtained with Mostofi's pattern, nuclear, sum, and worse grades, Johns Hopkins' grade, absolute tumor volume, nuclear DNA content measured by image cytophotometric study of Feulgen-stained histologic sections and flow cytometric study of propidium iodide-labeled suspensions of nuclei obtained from paraffin blocks, nonrandom sampled NRF of worse and most prevalent neoplastic areas, and prostatic acid phosphatase and peanut agglutinin immunohistochemical study. NRF measured by a random technique best predicted outcome in these patients with A2 prostatic carcinoma and should be evaluated prospectively as a means for selecting patients who require therapy.
在美国，每年进行的40万例前列腺切除术中，约10%或更多的病例会意外发现癌症。A2期癌症患者中只有35%会死于该疾病。为了改变这些患者的疾病进程，65%的A2期患者可能会接受根治性前列腺切除术、放射治疗或激素治疗，但这些治疗可能是不必要的。因此，需要一种准确的方法来预测A2期癌症患者的预后。18例A2期前列腺癌患者未经进一步治疗直至病情进展或未进展，由几位不了解患者预后的研究人员对其组织学切片进行评估，这些研究人员采用了标准病理分级系统以及形态计量学、细胞光度学、流式细胞术和免疫组织化学技术。通过随机抽样的绝对（18例中的17例）和相对（18例中的16例）核圆度因子（NRF）、以标本百分比表示的肿瘤体积（16例中的13例）、主要（18例中的13例）、次要（18例中的14例）、总和（18例中的15例）以及更差（18例中的14例）的Gleason分级和前列腺特异性抗原免疫组织化学结果（18例中的13例）能够正确预测预后，这些指标在两组之间产生了统计学上的显著差异。而Mostofi模式、核分级、总和及更差分级、约翰霍普金斯分级、绝对肿瘤体积、通过对福尔根染色组织学切片进行图像细胞光度学研究以及对从石蜡块中获得的碘化丙啶标记细胞核悬液进行流式细胞术研究测量的核DNA含量、更差和最常见肿瘤区域的非随机抽样NRF以及前列腺酸性磷酸酶和花生凝集素免疫组织化学研究均未产生显著差异。通过随机技术测量的NRF最能预测这些A2期前列腺癌患者的预后，应前瞻性地将其作为选择需要治疗患者的一种手段进行评估。
