Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37205, USA.
J Urol. 2010 Oct;184(4):1334-40. doi: 10.1016/j.juro.2010.06.041. Epub 2010 Aug 17.
Whole mount processing is more resource intensive than routine systematic sampling of radical retropubic prostatectomy specimens. We compared whole mount and systematic sampling for detecting pathological outcomes, and compared the prognostic value of pathological findings across pathological methods.
We included men (608 whole mount and 525 systematic sampling samples) with no prior treatment who underwent radical retropubic prostatectomy at Vanderbilt University Medical Center between January 2000 and June 2008. We used univariate and multivariate analysis to compare the pathological outcome detection rate between pathological methods. Kaplan-Meier curves and the log rank test were used to compare the prognostic value of pathological findings across pathological methods.
There were no significant differences between the whole mount and the systematic sampling groups in detecting extraprostatic extension (25% vs 30%), positive surgical margins (31% vs 31%), pathological Gleason score less than 7 (49% vs 43%), 7 (39% vs 43%) or greater than 7 (12% vs 13%), seminal vesicle invasion (8% vs 10%) or lymph node involvement (3% vs 5%). Tumor volume was higher in the systematic sampling group and whole mount detected more multiple surgical margins (each p <0.01). There were no significant differences in the likelihood of biochemical recurrence between the pathological methods when patients were stratified by pathological outcome.
Except for estimated tumor volume and multiple margins whole mount and systematic sampling yield similar pathological information. Each method stratifies patients into comparable risk groups for biochemical recurrence. Thus, while whole mount is more resource intensive, it does not appear to result in improved detection of clinically important pathological outcomes or prognostication.
全器官处理比常规系统取样根治性前列腺切除术标本更耗费资源。我们比较了全器官和系统取样在检测病理结果方面的效果，并比较了不同病理方法对病理发现的预后价值。
我们纳入了 2000 年 1 月至 2008 年 6 月期间在范德比尔特大学医学中心接受根治性前列腺切除术且无前期治疗的男性（608 例全器官和 525 例系统取样样本）。我们使用单变量和多变量分析比较了不同病理方法在检测病理结果方面的差异。Kaplan-Meier 曲线和对数秩检验用于比较不同病理方法对病理发现的预后价值。
在检测前列腺外延伸（25% vs 30%）、阳性手术边缘（31% vs 31%）、病理 Gleason 评分小于 7（49% vs 43%）、7（39% vs 43%）或大于 7（12% vs 13%）、精囊侵犯（8% vs 10%）或淋巴结受累（3% vs 5%）方面，全器官组和系统取样组之间没有显著差异。系统取样组的肿瘤体积较高，全器官组检测到更多的多个手术边缘（均 p <0.01）。当根据病理结果对患者进行分层时，不同病理方法在生化复发的可能性方面没有显著差异。
除了估计肿瘤体积和多个边缘外，全器官和系统取样都能提供相似的病理信息。每种方法都能将患者分为具有类似生化复发风险的亚组。因此，虽然全器官处理更耗费资源，但似乎并没有提高对临床重要病理结果的检测或预后的判断。
