Prostate Centre at Vancouver General Hospital, Vancouver, BC, Canada.
BJU Int. 2012 Mar;109(5):660-4. doi: 10.1111/j.1464-410X.2011.10543.x. Epub 2011 Sep 2.
• To determine the influence of tumour and prostate gland volumes on the underestimation of prostate cancer Gleason score in diagnostic core biopsies.
• Patients undergoing radical prostatectomy with matched diagnostic biopsies were identified from a prospectively recorded database. • Tumour volumes were measured in serial whole-mount sections with image analysis software as part of routine histological assessment. • Differences in various metrics of tumour and prostate volume between upgraded tumours and tumours concordant for the lower or higher grade were analysed.
• In all, 684 consecutive patients with Gleason score 6 or 7 prostate cancer on diagnostic biopsy were identified. • Of 298 patients diagnosed with Gleason 6 tumour on biopsy, 201 (67.4%) were upgraded to Gleason 7 or higher on final pathology. Similarly, of 262 patients diagnosed with Gleason 3 + 4 = 7 prostate cancer on initial biopsy, 60 (22.9%) were upgraded to Gleason score 4 + 3 = 7 or higher. • Tumours upgraded from Gleason 6 to 7 had a significantly lower index tumour volume (1.73 vs 2 mL, P= 0.029), higher calculated prostate volume (41.6 vs 39 mL, P= 0.017) and lower relative percentage of tumour to benign glandular tissue (4.3% vs 5.9%, P= 0.001) than tumours concordant for the higher grade. • Similarly, tumours that were Gleason score 3 + 4 on biopsy and upgraded on final pathology to 4 + 3 were significantly smaller as measured by both total tumour volume (2.3 vs 3.3 mL, P= 0.005) and index tumour volume (2.2 vs 3, P= 0.027) and occupied a smaller percentage of the gland volume (6.3% vs 8.9%, P= 0.017) compared with tumours concordant for the higher grade. • On multivariate analysis, lower prostate weight (hazard ratio 0.97, 95% confidence interval 0.96-0.99, P < 0.001) and larger total tumour volume (hazard ratio 1.87, 95% confidence interval 1.4-2.6, P < 0.001) independently predicted an upgrade in Gleason score from 6 to 7. In tumours upgraded from biopsy Gleason 3 + 4, only higher index tumour volume (hazard ratio 3.1, 95% confidence interval 1.01-9.3, P= 0.048) was a significant predictor of upgrading on multivariate analysis.
• Under-graded tumours are significantly smaller than tumours concordant for the higher grade, indicating that incomplete tumour sampling plays a significant role in Gleason score assignment error. • Surrogate measures of tumour volume may predict those at greatest risk of Gleason score upgrade.
从一个前瞻性记录的数据库中确定接受根治性前列腺切除术和匹配的诊断性活检的患者。
使用图像分析软件在连续的全组织切片中测量肿瘤体积，作为常规组织学评估的一部分。
分析肿瘤和前列腺体积的各种指标在升级肿瘤和与较低或较高等级一致的肿瘤之间的差异。
在所有诊断为活检中 Gleason 评分 6 或 7 的前列腺癌的 684 例连续患者中。
在 298 例诊断为活检 Gleason 6 肿瘤的患者中，201 例（67.4%）在最终病理学上升级为 Gleason 7 或更高。同样，在 262 例初始活检诊断为 Gleason 3+4=7 前列腺癌的患者中，60 例（22.9%）升级为 Gleason 评分 4+3=7 或更高。
从 Gleason 6 升级到 7 的肿瘤的指数肿瘤体积明显较低（1.73 与 2 毫升，P=0.029），计算的前列腺体积较高（41.6 与 39 毫升，P=0.017），肿瘤与良性腺组织的相对百分比较低（4.3%与 5.9%，P=0.001）与较高等级一致的肿瘤。
同样，活检中为 Gleason 3+4，最终病理学升级为 4+3 的肿瘤的总肿瘤体积（2.3 与 3.3 毫升，P=0.005）和指数肿瘤体积（2.2 与 3，P=0.027）明显较小，并且在腺体积中所占的比例较小（6.3%与 8.9%，P=0.017）与较高等级一致的肿瘤。
多变量分析显示，前列腺重量较低（危险比 0.97，95%置信区间 0.96-0.99，P<0.001）和总肿瘤体积较大（危险比 1.87，95%置信区间 1.4-2.6，P<0.001）独立预测 Gleason 评分从 6 升级到 7。在活检从 Gleason 3+4 升级的肿瘤中，只有较高的指数肿瘤体积（危险比 3.1，95%置信区间 1.01-9.3，P=0.048）是多变量分析中升级的显著预测因子。
分级较低的肿瘤明显小于与较高等级一致的肿瘤，表明不完全的肿瘤取样在 Gleason 评分赋值错误中起着重要作用。
肿瘤体积的替代测量值可能预测那些最有可能升级为 Gleason 评分的风险。
