Marks Rebecca A, Lin Haiqun, Koch Michael O, Cheng Liang
Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Am J Surg Pathol. 2007 Jun;31(6):877-81. doi: 10.1097/01.pas.0000213429.61374.4f.
Tumor volume has been considered an important variable in determining the probability of prostate-specific antigen (PSA) recurrence in prostatic adenocarcinoma. There have been many studies that have tried to determine an appropriate method of calculating tumor volume, but no single methodology has been agreed upon. We tested the hypothesis that the ratio of tumor positive tissue blocks to the total number of blocks submitted (positive-block ratio) can be used as an independent prognostic indicator for PSA recurrence. We analyzed 504 patients who underwent total radical retropubic prostatectomy between 1990 and 1998. None of the patients had preoperative radiation or androgen-deprivation therapy. Clinical records were reviewed. The mean positive-block ratio was 0.44 (median, 0.43; range, 0.05 to 1.0). The positive block-ratio was significantly associated with Gleason score, pathologic stage, surgical margin status, extraprostatic extension, seminal vesical invasion, lymph node metastasis, perineural invasion, and preoperative serum PSA level (all P<0.001). Using a multivariate Cox regression model, controlling for pathologic stage, Gleason score, lymph node metastasis, and surgical margin status, positive-block ratio was an independent predictor of PSA recurrence (hazard ratio, 2.3; 95% confidence interval, 1.06-4.83; P=0.03). Five-year PSA recurrence-free survival was 67% for those patients with positive-block ratio <or=0.43, as compared with 42% those with positive-block ratio >0.43 (P<0.001). Positive-block ratio is an independent predictor of PSA recurrence and this simple method of tumor measurement seems to be promising for quantifying tumor volume if our findings are validated by subsequent reports.
肿瘤体积一直被视为决定前列腺腺癌患者前列腺特异性抗原（PSA）复发概率的一个重要变量。已有许多研究试图确定一种合适的计算肿瘤体积的方法，但尚未就单一方法达成共识。我们检验了这样一个假设，即肿瘤阳性组织块与送检总组织块数的比值（阳性块比值）可作为PSA复发的独立预后指标。我们分析了1990年至1998年间接受根治性耻骨后前列腺切除术的504例患者。所有患者术前均未接受放疗或雄激素剥夺治疗。我们查阅了临床记录。平均阳性块比值为0.44（中位数为0.43；范围为0.05至1.0）。阳性块比值与Gleason评分、病理分期、手术切缘状态、前列腺外侵犯、精囊侵犯、淋巴结转移、神经周围侵犯及术前血清PSA水平均显著相关（所有P<0.001）。使用多因素Cox回归模型，在控制病理分期、Gleason评分、淋巴结转移和手术切缘状态后，阳性块比值是PSA复发的独立预测因素（风险比为2.3；95%置信区间为1.06 - 4.83；P = 0.03）。阳性块比值≤0.43的患者5年无PSA复发生存率为67%，而阳性块比值>0.43的患者为42%（P<0.001）。阳性块比值是PSA复发的独立预测因素，如果我们的研究结果能得到后续报告的验证，那么这种简单的肿瘤测量方法在量化肿瘤体积方面似乎很有前景。
