Division of Urology, Department of Surgery, Duke Prostate Center, Duke University Medical Center, DUMC 2804, Durham, NC 27710, USA.
Med Oncol. 2012 Dec;29(5):3339-44. doi: 10.1007/s12032-012-0270-4. Epub 2012 Jun 12.
To find the predictors of Gleason score upgrading in a cohort of low-risk prostate cancer patients, data were analyzed comprising 1,632 consecutive men with low-risk prostate cancer who underwent radical prostatectomy between 1993 and 2009. Assessment focused on preoperative parameters including patient age, race, diagnostic prostate-specific antigen (PSA) levels, clinical stage and biopsy Gleason score, along with pathological parameters including percentage of tumor involvement (PTI), tumor laterality, pathological stage, extra-capsular extension, seminal vesicle invasion, and surgical margins. These parameters were analyzed using univariate and multivariate methods. Kaplan-Meier curves compared differences in biochemical disease-free survival in men having cancers with and without Gleason score upgrading. Cases involving pathological Gleason score upgrading were identified in 723 (44.3 %) of 1,632 patients. Kaplan-Meier PSA recurrence-free survival curves showed a difference in outcome between men with and without Gleason score upgrading (p < 0.001). Of Gleason score upgraded patients, 35 (4.8 %) men had PTI of <5 %, 237 (32.8 %) had PTI of 5-9.9 %, 177 (24.5 %) had PTI of 10-14.9 %, and 274 (37.9 %) had PTI ≥ 15 % (p < 0.001). PTI (p < 0.001) along with diagnostic PSA, patient age, diagnostic biopsy Gleason score, pathologic stage, and surgical margin status were independent predictors of pathological Gleason score upgrading on multivariate logistic regression. PTI correlates closely with Gleason score upgrading in a low-risk prostate cancer cohort. Low-risk prostate cancer patients with clinical findings suggestive of high PTI or large volume cancers should not benefit from active surveillance strategies.
为了找到低危前列腺癌患者中 Gleason 评分升级的预测因素，分析了 1993 年至 2009 年间接受根治性前列腺切除术的 1632 例连续低危前列腺癌患者的数据。评估重点包括术前参数，包括患者年龄、种族、诊断前列腺特异性抗原 (PSA) 水平、临床分期和活检 Gleason 评分，以及病理参数，包括肿瘤累及百分比 (PTI)、肿瘤侧别、病理分期、包膜外延伸、精囊侵犯和手术切缘。这些参数使用单变量和多变量方法进行分析。Kaplan-Meier 曲线比较了有和无 Gleason 评分升级的癌症患者在生化无病生存方面的差异。在 1632 例患者中，有 723 例 (44.3%) 发生了病理 Gleason 评分升级。Kaplan-Meier PSA 无复发生存曲线显示，Gleason 评分升级的男性与无 Gleason 评分升级的男性之间的结果存在差异 (p < 0.001)。在 Gleason 评分升级的患者中，35 例 (4.8%) 患者的 PTI < 5%，237 例 (32.8%) 患者的 PTI 为 5-9.9%，177 例 (24.5%) 患者的 PTI 为 10-14.9%，274 例 (37.9%) 患者的 PTI≥15% (p < 0.001)。PTI (p < 0.001) 以及诊断 PSA、患者年龄、诊断活检 Gleason 评分、病理分期和手术切缘状态是多变量逻辑回归中病理 Gleason 评分升级的独立预测因素。PTI 与低危前列腺癌队列中的 Gleason 评分升级密切相关。具有高 PTI 或大体积肿瘤临床特征的低危前列腺癌患者不应受益于主动监测策略。
