Department of Pathology, The Johns Hopkins Hospital, 401 N. Broadway Street, Baltimore, MD 21231, USA.
Am J Surg Pathol. 2011 Sep;35(9):1351-5. doi: 10.1097/PAS.0b013e3182217b79.
Currently, there is no consensus as to the optimal method for measuring tumor length or percentage of cancer on a core when there are 2 or more foci of prostate cancer in a single core separated by benign intervening stroma. One option is to measure discontinuous foci of cancer as if they were 1 single continuous focus. The other option is to add the measurements of the individual separate foci of cancer, ignoring the extent of the intervening benign prostate tissue. The surgical pathology database at The Johns Hopkins Hospital was searched for outside consult cases of prostate needle biopsies reviewed between 2005 and 2010 when the patient came to our institution for radical prostatectomy (RP). Cases were restricted to those with biopsy Gleason score 6 in which there was at least 15% discordance between the outside and our institution in terms of the reported highest percentage of cancer per core per case. One hundred and nine patients were identified fulfiling our inclusion criteria. Seventy-nine showed the same Gleason score in the RP, and 30 had an upgrade to Gleason ≥7. Including all cases (scores 6, 7, and 8 at RP), there was no significant association between the maximum percentage of cancer per core with organ-confined disease or risk of positive surgical margins, regardless if the cores were measured at Hopkins or at the outside institutions. For cases with no upgrade at RP, the differences between the maximum percentage of cancer per core per case recorded at Hopkins and the outside institutions ranged from 15% to 80%, in which the mean and median differences were 35% and 30%, respectively. The maximum percentages of tumor involvement on a core per case given at our institution more strongly correlated with the presence of organ-confined disease (P=0.004) compared with the percentages given at the outside institutions (P=0.027). Surgical margin positivity was also associated with the maximum percentages of tumor involvement per core given at our institution (P=0.004), whereas the outside percentages were not significant predictors of margin status (P=0.2). In a multivariable analysis, maximum percentage of cancer per core per case measured at Hopkins which includes intervening benign prostate tissue in the measurement was also more predictive of stage and margins than ignoring intervening benign tissue. In summary, our study demonstrated that for prostate cancer in which the needle biopsy grade is representative of the entire tumor, quantifying cancer extent on biopsy by measuring discontinuous cancer on biopsy from one end to the other as opposed to "collapsing" the cancer by subtracting out the intervening benign prostate tissue correlates better with organ-confined disease and risk of positive margins.
目前，当一个核心中有 2 个或更多前列腺癌病灶且被良性间质分隔时，对于测量肿瘤长度或癌组织百分比，尚无共识。一种方法是将不连续的癌灶视为单个连续病灶进行测量。另一种方法是分别测量各个独立的癌灶，而忽略其间的良性前列腺组织的范围。约翰霍普金斯医院的外科病理学数据库被检索到 2005 年至 2010 年期间为我院行根治性前列腺切除术（RP）而来的外院会诊前列腺针吸活检病例。这些病例仅限于活检 Gleason 评分 6 分的病例，这些病例在外院和我院报告的每例核心中癌组织的最高百分比之间存在至少 15%的差异。符合我们纳入标准的患者共 109 例。其中 79 例在 RP 中显示相同的 Gleason 评分，30 例升级为 Gleason≥7。包括所有病例（RP 为 6、7 和 8 分），核心中最大的癌组织百分比与器官局限性疾病或阳性切缘风险之间无显著相关性，无论核心是在霍普金斯医院还是外院测量。对于 RP 无升级的病例，霍普金斯医院和外院记录的每例核心中最大癌组织百分比的差异范围为 15%至 80%，平均值和中位数差异分别为 35%和 30%。与外院相比，我院记录的每例核心中肿瘤累及的最大百分比与器官局限性疾病的存在更密切相关（P=0.004）。（P=0.027）。我院记录的每例核心中肿瘤累及的最大百分比也与切缘阳性显著相关（P=0.004），而外院的百分比不是切缘状态的显著预测因素（P=0.2）。在多变量分析中，包括测量中的良性前列腺组织在内，霍普金斯医院测量的每例核心中最大的癌组织百分比也比忽略其间的良性组织更能预测肿瘤分期和切缘。总之，我们的研究表明，对于针吸活检分级代表整个肿瘤的前列腺癌，通过从一端到另一端测量活检中的不连续癌组织来定量活检中的癌组织范围，而不是通过减去其间的良性前列腺组织来“折叠”癌组织，与器官局限性疾病和阳性切缘风险的相关性更好。
