Department of Urology, Joetsu 942-8502, Japan.
Diagn Pathol. 2012 Jun 14;7:68. doi: 10.1186/1746-1596-7-68.
The prediction of pathological outcomes prior to surgery remains a challenging problem for the appropriate surgical indication of prostate cancer. This study was performed to identify preoperative values predictive of pathological and oncological outcomes based on standardized extended prostate biopsies with core histological results diagrammed/mapped in patients receiving radical prostatectomy for prostate cancer clinically diagnosed as localized or locally advanced disease.
In 124 patients with clinically localized or locally advanced prostate cancer (cT1c-cT3a) without prior treatment, pathological outcomes on the surgical specimen including seminal vesicle involvement (SVI), positive surgical margin (PSM), and perineural invasion (PNI) were studied in comparison with clinical parameters based on the results of 14-core prostate biopsies comprising sextant, laterally-directed sextant, and bilateral transition zone (TZ) sampling.
Concerning the association of pathological outcomes with oncological outcomes, patients with PSM and PNI on surgical specimens had poorer biochemical-progression-free survival than those without PSM (logrank p = 0.002) and PNI (p = 0.003); it was also poorer concerning SVI, although the difference was not significant (p = 0.120). Concerning the impact of clinical parameters on these pathological outcomes, positive TZ and multiple positive biopsy cores in the prostatic middle were independent values predictive of SVI with multivariate analyses (p = 0.020 and p = 0.025, respectively); both positive TZ and multiple positive prostatic middle biopsies were associated with larger tumor volume (p < 0.001 in both). The percentage of positive biopsy cores (%positive cores) and biopsy Gleason score were independent values predictive of PSM (p = 0.001) and PNI (p = 0.001), respectively. Multiple positive cores in the prostatic base were associated with proximal/bladder-side PSM (p < 0.001), and also linked to poorer biochemical-progression-free survival (p = 0.004). Clinical T stage had no association with these pathological outcomes.
%positive cores and Gleason score in extended biopsies were independent values predictive of PSM and PNI in prostate cancer clinically diagnosed as localized or locally advanced disease, respectively, which were associated with poorer oncological outcomes. When diagramming biopsy-core results, extended biopsy may provide additional information for predicting oncological and pathological outcomes including SVI in patients clinically diagnosed as having localized or locally advanced disease.
The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/8790262771042628.
在手术前预测病理结果仍然是前列腺癌适当手术适应证的一个具有挑战性的问题。本研究旨在确定术前值，这些值可预测接受根治性前列腺切除术的前列腺癌患者的病理和肿瘤学结果，这些患者在接受治疗前接受了临床诊断为局限性或局部进展性疾病的前列腺癌的标准化扩展前列腺活检，活检标本中包含芯组织学结果图/映射。
在 124 例临床局限性或局部进展性前列腺癌（cT1c-cT3a）患者中，这些患者未经治疗，比较了 14 芯前列腺活检的临床参数与手术标本中的病理结果，包括精囊侵犯（SVI）、阳性切缘（PSM）和神经周围侵犯（PNI）。这些活检包含了前区、外侧区和双侧移行区（TZ）采样。
关于病理结果与肿瘤学结果的相关性，手术标本中存在 PSM 和 PNI 的患者与无 PSM（logrank p = 0.002）和 PNI（p = 0.003）的患者相比，生化无进展生存率较差；SVI 也较差，尽管差异无统计学意义（p = 0.120）。关于临床参数对这些病理结果的影响，多区阳性 TZ 和前列腺中部多个阳性活检芯是 SVI 的独立预测因素（多变量分析，p = 0.020 和 p = 0.025）；两者均与较大的肿瘤体积相关（p < 0.001）。阳性活检芯的百分比（%阳性芯）和活检 Gleason 评分是 PSM（p = 0.001）和 PNI（p = 0.001）的独立预测因素。前列腺基底部的多个阳性核心与近端/膀胱侧 PSM 相关（p < 0.001），与较差的生化无进展生存率也相关（p = 0.004）。临床 T 分期与这些病理结果无相关性。
在临床诊断为局限性或局部进展性疾病的前列腺癌中，扩展活检中的%阳性芯和 Gleason 评分是 PSM 和 PNI 的独立预测因素，它们与较差的肿瘤学结果相关。在对活检芯结果进行绘图时，扩展活检可能为预测包括 SVI 在内的局部或局部进展性疾病患者的肿瘤学和病理学结果提供额外信息。
