Reis Leonardo Oliveira, Zani Emerson Luis, Freitas Leandro L L, Denardi Fernandes, Billis Athanase
Departments of Urology and Pathology, Faculty of Medical Sciences, University of Campinas (Unicamp), Rua Tessália Vieira de Camargo 126, Cidade Universitária "Zeferino Vaz," 13083-887 Campinas-SP, Brazil.
Adv Urol. 2013;2013:710421. doi: 10.1155/2013/710421. Epub 2013 Oct 31.
Background. Protective factors against Gleason upgrading and its impact on outcomes after surgery warrant better definition. Patients and Methods. Consecutive 343 patients were categorized at biopsy (BGS) and prostatectomy (PGS) as Gleason score, ≤6, 7, and ≥8; 94 patients (27.4%) had PSA recurrence, mean followup 80.2 months (median 99). Independent predictors of Gleason upgrading (logistic regression) and disease-free survival (DFS) (Kaplan-Meier, log-rank) were determined. Results. Gleason discordance was 45.7% (37.32% upgrading and 8.45% downgrading). Upgrading risk decreased by 2.4% for each 1 g of prostate weight increment, while it increased by 10.2% for every 1 ng/mL of PSA, 72.0% for every 0.1 unity of PSA density and was 21 times higher for those with BGS 7. Gleason upgrading showed increased clinical stage (P = 0.019), higher tumor extent (P = 0.009), extraprostatic extension (P = 0.04), positive surgical margins (P < 0.001), seminal vesicle invasion (P = 0.003), less "insignificant" tumors (P < 0.001), and also worse DFS, χ (2) = 4.28, df = 1, P = 0.039. However, when setting the final Gleason score (BGS ≤6 to PGS 7 versus BGS 7 to PGS 7), avoiding allocation bias, DFS impact is not confirmed, χ (2) = 0.40, df = 1, P = 0.530.Conclusions. Gleason upgrading is substantial and confers worse outcomes. Prostate weight is inversely related to upgrading and its protective effect warrants further evaluation.
背景。针对Gleason分级升级的保护因素及其对手术后结局的影响需要更明确的界定。患者与方法。连续纳入343例患者，根据活检（BGS）和前列腺切除术（PGS）时的Gleason评分分为≤6分、7分和≥8分；94例患者（27.4%）出现PSA复发，平均随访80.2个月（中位数99个月）。确定Gleason分级升级的独立预测因素（逻辑回归）和无病生存期（DFS）（Kaplan-Meier法，对数秩检验）。结果。Gleason分级不一致率为45.7%（升级37.32%，降级8.45%）。前列腺重量每增加1克，升级风险降低2.4%，而PSA每增加1 ng/mL，升级风险增加10.2%，PSA密度每增加0.1个单位，升级风险增加72.0%，BGS为7分者的升级风险是其他患者的21倍。Gleason分级升级表现为临床分期增加（P = 0.019）、肿瘤范围扩大（P = 0.009）、前列腺外侵犯（P = 0.04）、手术切缘阳性（P < 0.001）、精囊侵犯（P = 0.003）、“微小”肿瘤较少（P < 0.001），DFS也较差，χ(2)=4.28，自由度=1，P = 0.039。然而，当设定最终Gleason评分（BGS≤6分到PGS 7分与BGS 7分到PGS 7分）时，避免分配偏倚后，未证实DFS受到影响，χ(2)=0.40，自由度=1，P = 0.530。结论。Gleason分级升级情况较为显著，且与更差的结局相关。前列腺重量与分级升级呈负相关，其保护作用值得进一步评估。
