Cheng Liang, Davidson Darrell D, Lin Haiqun, Koch Michael O
Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Cancer. 2007 Nov 1;110(9):1967-72. doi: 10.1002/cncr.23004.
Morphologic and clinical heterogeneity within tumor grades is well recognized in prostate cancer. The objective of the current study was to determine whether the combined percentage of Gleason patterns 4 and 5 in radical prostatectomy specimens is an independent predictor of cancer-specific survival in prostate cancer patients.
The radical prostatectomy specimens were analyzed from 504 consecutive prostate cancer patients who were treated at Indiana University Medical Center between 1990 and 1998. Various clinical and pathologic characteristics were analyzed.
A higher combined percentage of Gleason patterns 4 and 5 was associated with older age, higher preoperative serum prostate-specific antigen level, higher pathologic stage, positive surgical margins, extraprostatic extension of tumor, higher Gleason score, perineural invasion, and lymph node metastasis. In the multivariate Cox regression model, the combined percentage of Gleason patterns 4 and 5 was found to be an independent predictor of cancer-specific survival (P = .04).
The combined percentage of Gleason patterns 4 and 5 is a powerful predictor of prostate cancer-specific survival. Assessment of high-grade cancer amounts may allow for better stratification of patients into appropriate prognostic groups and treatment protocols.
前列腺癌中肿瘤分级内的形态学和临床异质性已得到充分认识。本研究的目的是确定根治性前列腺切除标本中Gleason 4级和5级模式的联合百分比是否是前列腺癌患者癌症特异性生存的独立预测因素。
对1990年至1998年在印第安纳大学医学中心接受治疗的504例连续前列腺癌患者的根治性前列腺切除标本进行分析。分析了各种临床和病理特征。
Gleason 4级和5级模式的联合百分比越高，与年龄越大、术前血清前列腺特异性抗原水平越高、病理分期越高、手术切缘阳性、肿瘤前列腺外侵犯、Gleason评分越高、神经周围侵犯和淋巴结转移相关。在多变量Cox回归模型中，发现Gleason 4级和5级模式的联合百分比是癌症特异性生存的独立预测因素（P = 0.04）。
Gleason 4级和5级模式的联合百分比是前列腺癌特异性生存的有力预测因素。评估高级别癌的数量可能有助于将患者更好地分层到适当的预后组和治疗方案中。
