Schwartz David J, Sengupta Shomik, Hillman David W, Sargent Daniel J, Cheville John C, Wilson Torrence M, Mynderse Lance A, Choo Richard, Davis Brian J
Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
Int J Radiat Oncol Biol Phys. 2007 Oct 1;69(2):411-8. doi: 10.1016/j.ijrobp.2007.03.016.
Extraprostatic extension (EPE) of tumor conveys an adverse prognosis in early-stage prostate cancer. Previous studies reported on the linear and radial distance of EPE (EPEr) as measured from the prostate edge. In this study, the correlation of the EPEr from a large whole mount prostatectomy series was determined with respect to the needle biopsy and prostatectomy specimen findings.
In a 24-month period, 404 patients underwent radical prostatectomy and the specimens were whole mounted. The preoperative records, biopsy findings, and EPEr from these specimens were evaluated.
The range of the EPEr distance was 0.0-5.7 mm. A three-category model was used that included 283 patients (70%) with no EPE, 59 (15%) with "near EPE" (range, 0.01-0.59 mm), and 62 (15%) with "far EPE" (>or=0.6 mm). Univariate analysis revealed that patient age and prostate volume did not correlate with EPEr, in contrast to all other factors evaluated. Multivariate analysis identified the preoperative serum prostate-specific antigen, the percentage of cancer in the biopsy cores, and clinical tumor stage as significant. However, the Gleason score was not associated with the EPEr. Greater discrimination was possible in estimating the probability of extension in the "near" category than in the "far" category.
EPEr is associated with the preoperative prostate-specific antigen level, percentage of cancer in the biopsy cores, and clinical tumor stage. These data might be useful in planning local therapies for prostate cancer, but additional studies identifying factors associated with EPEr beyond 3-5 mm could have relevance regarding the appropriate radiotherapeutic management strategies.
肿瘤的前列腺外扩展（EPE）在早期前列腺癌中预示着不良预后。以往研究报道了从前列腺边缘测量的EPE的线性和径向距离（EPEr）。在本研究中，针对穿刺活检和前列腺切除标本的结果，确定了来自大量前列腺整体切除系列的EPEr的相关性。
在24个月期间，404例患者接受了根治性前列腺切除术，标本进行了整体装片。对这些标本的术前记录、活检结果和EPEr进行了评估。
EPEr距离范围为0.0 - 5.7毫米。采用了一个三类模型，其中包括283例（70%）无EPE的患者、59例（15%）“接近EPE”（范围为0.01 - 0.59毫米）的患者和62例（15%）“远处EPE”（≥0.6毫米）的患者。单因素分析显示，与所有其他评估因素相反，患者年龄和前列腺体积与EPEr无关。多因素分析确定术前血清前列腺特异性抗原、活检核心中的癌症百分比和临床肿瘤分期具有显著性。然而，Gleason评分与EPEr无关。在估计“接近”类别中扩展的可能性方面比“远处”类别更具辨别力。
EPEr与术前前列腺特异性抗原水平、活检核心中的癌症百分比和临床肿瘤分期相关。这些数据可能有助于规划前列腺癌的局部治疗，但进一步研究确定超过3 - 5毫米的EPEr相关因素可能与适当的放射治疗管理策略相关。
