Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37203, USA.
J Urol. 2011 Dec;186(6):2221-7. doi: 10.1016/j.juro.2011.07.104. Epub 2011 Oct 19.
Gleason score upgrading between biopsy and surgical pathological specimens occurs in 30% to 50% of cases. Predicting upgrading in men with low risk prostate cancer may be particularly important since high grade disease influences management decisions and impacts prognosis. We determined whether prostate size predicts Gleason score upgrading in patients with low risk prostate cancer.
A total of 1,251 consecutive patients with D'Amico low risk disease and complete data available underwent radical prostatectomy at our institution between January 2000 and June 2008. Patients were divided into 3 groups by pathological Gleason score, including no, minor (3 + 4 = 7) and major (4 + 3 = 7 or greater) Gleason score upgrading. We developed bivariate and multivariate models to determine whether prostate size was an important predictor of upgrading while controlling for clinical and biopsy characteristics.
Of 1,251 cases 387 (31.0%) were upgraded, including 324 (26%) and 63 (5%) with minor and major upgrading, respectively. As expected, Gleason score upgrading was associated with worse pathological and cancer control outcomes. On multivariate analysis smaller prostate size was an independent predictor of any and major upgrading (OR 0.58, 95% CI 0.48-0.69, p <0.01 and OR 0.67, 95% CI 0.49-0.96, p = 0.03, respectively). Men with prostate volume at the 25th percentile (36 cm(3)) were 50% more likely to experience upgrading than men with prostate volume at the 75th percentile (58 cm(3)).
Of low risk cases 31% were upgraded at final pathology. Smaller prostate size predicts Gleason score upgrading in men with clinically low risk prostate cancer. This is important information when counseling patients on management and prognosis.
在活检和手术病理标本中，Gleason 评分升级发生在 30%至 50%的病例中。预测低危前列腺癌患者的升级可能尤为重要，因为高级别疾病会影响治疗决策并影响预后。我们确定前列腺体积是否可以预测低危前列腺癌患者的 Gleason 评分升级。
2000 年 1 月至 2008 年 6 月期间，我们机构对 1251 例 D'Amico 低危疾病患者进行了连续研究，所有患者均行根治性前列腺切除术且有完整资料。根据病理 Gleason 评分，患者分为 3 组，包括无、轻度（3+4=7）和重度（4+3=7 或更高）评分升级。我们建立了双变量和多变量模型，以确定前列腺体积是否是预测升级的重要因素，同时控制临床和活检特征。
在 1251 例患者中，387 例（31.0%）发生升级，其中 324 例（26%）和 63 例（5%）分别为轻度和重度升级。正如预期的那样，Gleason 评分升级与较差的病理和癌症控制结果相关。多变量分析显示，前列腺体积较小是任何升级和主要升级的独立预测因素（OR 0.58，95%CI 0.48-0.69，p<0.01 和 OR 0.67，95%CI 0.49-0.96，p=0.03）。前列腺体积处于第 25 百分位（36cm³）的男性发生升级的可能性比前列腺体积处于第 75 百分位（58cm³）的男性高 50%。
在最终病理中，31%的低危病例发生升级。较小的前列腺体积可以预测低危前列腺癌患者的 Gleason 评分升级。当向患者提供管理和预后方面的咨询时，这是重要的信息。
