Boorjian Stephen A, Karnes R Jeffrey, Crispen Paul L, Rangel Laureano J, Bergstralh Eric J, Sebo Thomas J, Blute Michael L
Department of Urology, Health Sciences Research, and Laboratory Medicine and Pathology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota, USA.
J Urol. 2009 Jan;181(1):95-104; discussion 104. doi: 10.1016/j.juro.2008.09.016. Epub 2008 Nov 13.
Although discordance in the Gleason score between biopsy and radical prostatectomy specimens has been well recognized, the prognostic importance of this discrepancy has not been definitively established. We investigated the association of Gleason score discordance with postoperative systemic progression and death from prostate cancer.
We evaluated the records of 8,054 consecutive patients who underwent radical prostatectomy between 1987 and 2003. Gleason score at biopsy and prostatectomy was categorized as 6 or less, 3 + 4, 4 + 3 and 8 to 10. Cox proportional hazard regression models were used to analyze the impact of biopsy Gleason score on postoperative survival in patients in each pathological Gleason score stratum.
Discordance in Gleason score was associated with adverse pathological features, including advanced tumor stage, lymph node metastasis and positive surgical margins (each p <0.001). On multivariate analysis increasing biopsy Gleason score was significantly associated with systemic progression in patients with pathological 3 + 4 and 8 to 10 cancer (HR 1.44, 95% CI 1.17-1.76, p <0.001 and HR 1.24, 95% CI 1.03-1.48, p = 0.023, respectively). It was also an independent predictor of death from prostate cancer in patients with pathological Gleason 3 + 4 tumors (HR 1.62, 95% CI 1.23-2.15, p <0.001). However, adding biopsy Gleason score to our institutional Gleason score, prostate specific antigen, and seminal vesicle and margin status scoring algorithm minimally increased the concordance statistic for the association of that algorithm with cancer specific mortality from 0.827 to 0.842.
Biopsy Gleason score predicts systemic progression and cancer death in patients with pathological Gleason 3 + 4 tumors. Nevertheless, adding biopsy Gleason score to Gleason score, prostate specific antigen, and seminal vesicle and margin status did little to increase the predictive value of the model, which emphasizes the relative importance of pathological criteria for risk stratification.
虽然活检标本与根治性前列腺切除术标本之间的Gleason评分不一致已得到充分认识，但这种差异的预后重要性尚未最终确定。我们研究了Gleason评分不一致与前列腺癌术后全身进展和死亡之间的关联。
我们评估了1987年至2003年间连续8054例行根治性前列腺切除术患者的记录。活检和前列腺切除时的Gleason评分分为6分及以下、3+4、4+3和8至10分。采用Cox比例风险回归模型分析各病理Gleason评分层患者活检Gleason评分对术后生存的影响。
Gleason评分不一致与不良病理特征相关，包括肿瘤分期进展、淋巴结转移和手术切缘阳性（各p<0.001）。多因素分析显示，活检Gleason评分升高与病理3+4和8至10分癌症患者的全身进展显著相关（HR分别为1.44，95%CI 1.17-1.76，p<0.001和HR 1.24，95%CI 1.03-1.48，p=0.023）。它也是病理Gleason 3+4肿瘤患者前列腺癌死亡的独立预测因素（HR 1.62，95%CI 1.23-2.15，p<0.001）。然而，将活检Gleason评分添加到我们机构的Gleason评分、前列腺特异性抗原以及精囊和切缘状态评分算法中，该算法与癌症特异性死亡率关联的一致性统计量仅从0.827略有增加至0.842。
活检Gleason评分可预测病理Gleason 3+4肿瘤患者的全身进展和癌症死亡。然而，将活检Gleason评分添加到Gleason评分、前列腺特异性抗原以及精囊和切缘状态中，对增加模型的预测价值作用不大，这强调了病理标准在风险分层中的相对重要性。
