Cumming J A, Ritchie A W, Goodman C M, McIntyre M A, Chisholm G D
University Department of Surgery/Urology, Western General Hospital, Edinburgh.
Br J Urol. 1990 Mar;65(3):271-4. doi: 10.1111/j.1464-410x.1990.tb14725.x.
There is little information on histological changes in prostate cancer during the course of the disease. We have studied 74 patients with carcinoma of the prostate who required 2 transurethral resections of the prostate (mean interval between resections 2.4 years). They constituted 18.4% of all patients with carcinoma of the prostate presenting to our clinic between January 1978 and April 1988. All tumours were staged by conventional methods and graded using the Gleason system. The Gleason sum score in those patients with tumour in both specimens increased in 49, remained constant in 12 and decreased in 7. Within this group were 34 patients who were treated expectantly. The mean Gleason sum scores in this group increased, with a concomitant increase in local tumour stage and development of metastases. Although this was not a randomised trial, there was no significant difference in survival between patients having "deferred" management and those treated immediately, either from time of diagnosis or from time of second resection. There was, however, a significant difference in the time to second resection, with the "deferred" group requiring repeat resection on average 1 year earlier. This study confirmed the concept of tumour de-differentiation with time and showed that this phenomenon occurs in both treated and untreated tumours. Although overall survival was not influenced by the type of initial therapy or its timing, local progression, as assessed by the need for further TURP, occurred earlier in those not receiving immediate therapy.
关于前列腺癌病程中的组织学变化，相关信息较少。我们研究了74例需要进行2次经尿道前列腺切除术的前列腺癌患者（两次切除术之间的平均间隔时间为2.4年）。他们占1978年1月至1988年4月期间到我们诊所就诊的所有前列腺癌患者的18.4%。所有肿瘤均采用传统方法进行分期，并使用Gleason系统进行分级。在两次标本中均有肿瘤的患者中，Gleason总分增加的有49例，保持不变的有12例，降低的有7例。该组中有34例患者接受了观察等待治疗。该组患者的平均Gleason总分增加，同时局部肿瘤分期增加且出现转移。尽管这不是一项随机试验，但无论是从诊断时间还是从第二次切除时间来看，接受“延迟”治疗的患者与立即接受治疗的患者在生存率方面没有显著差异。然而，在第二次切除的时间上存在显著差异，“延迟”组平均需要提前1年进行再次切除。这项研究证实了肿瘤随时间去分化的概念，并表明这种现象在接受治疗和未接受治疗的肿瘤中均会发生。尽管总体生存率不受初始治疗类型或其时机的影响，但通过进一步经尿道前列腺切除术的需求评估，局部进展在未接受立即治疗的患者中出现得更早。
