Division of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Urol. 2011 Feb;185(2):489-94. doi: 10.1016/j.juro.2010.09.093. Epub 2010 Dec 17.
We evaluated the clinicopathological characteristics of single focus prostate cancer in radical prostatectomies, its clinical relevance and the occurrence of TMPRSS2-ERG rearrangement.
We reviewed the records of 1,100 radical prostatectomies and determined the tumor outline and number of cancer foci. When single focus prostate cancer was identified, we recorded pathological characteristics. We assessed ERG fusion status in a subset of cases.
Single focus prostate cancer was identified in 106 radical prostatectomies. Median patient age was 59 years. Median prostate specific antigen was 5.1 ng/ml. Single focus cancer was unilateral in 81% of cases and 98% originated from the peripheral zone. Tumor volume was 0.1 to 3.9 cm(3) (median 0.5). Gleason score was 6 in 38% of patients, 7 in 40%, 8 or greater in 21% and undetermined in 2%. Extraprostatic extension and seminal vesicles invasion were detected in 30% and 2% of cases, respectively. Stage was pT2 in 62% of cases, pT2 with positive margin of resection in 7% and pT3 in 30%. ERG fusion was detected in 68% of tumors. Cases rearranged via deletion had significantly higher tumor volume. Three cases showed intratumor heterogeneity.
Single focus prostate cancer accounted for 9.6% of tumors. In most cases it involved 1 lobe of the gland and originated from the peripheral zone. Despite a trend toward high grade disease 62% of single focus prostate cancers were organ confined. Only 3 fusion positive cases showed intratumor heterogeneity, suggesting that most single focus cancer may evolve from a single clone of malignant cells.
我们评估了根治性前列腺切除术中单灶前列腺癌的临床病理特征、其临床相关性以及 TMPRSS2-ERG 重排的发生情况。
我们复习了 1100 例根治性前列腺切除术的病历记录，确定了肿瘤轮廓和癌灶数量。当发现单灶前列腺癌时，我们记录了病理特征。我们对部分病例评估了 ERG 融合状态。
在 106 例根治性前列腺切除术中发现了单灶前列腺癌。患者中位年龄为 59 岁，中位前列腺特异抗原为 5.1ng/ml。单灶癌在 81%的病例中为单侧，98%起源于外周带。肿瘤体积为 0.1 至 3.9cm3（中位数为 0.5cm3）。Gleason 评分 6 分者占 38%，7 分者占 40%，8 分或更高者占 21%，评分不确定者占 2%。分别有 30%和 2%的病例出现了前列腺外侵犯和精囊侵犯。62%的病例分期为 pT2，7%为 pT2 且切缘阳性，30%为 pT3。在 68%的肿瘤中检测到了 ERG 融合。通过缺失发生重排的病例肿瘤体积明显更大。有 3 例显示肿瘤内异质性。
单灶前列腺癌占肿瘤的 9.6%。在大多数情况下，它累及腺体的 1 个叶且起源于外周带。尽管有高级别疾病的趋势，但 62%的单灶前列腺癌为器官局限。仅有 3 例融合阳性病例显示肿瘤内异质性，提示大多数单灶癌可能由单个恶性细胞克隆演变而来。
