1Department of Urology, Stanford University School of Medicine, Stanford 2Cancer Prevention Institute of California, Fremont 3Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA.
Pathology. 2014 Jun;46(4):306-10. doi: 10.1097/PAT.0000000000000097.
Based on revisions of Gleason scoring in 2005, it has been reported that nodal metastases at radical prostatectomy in Gleason 3 + 3 = 6 (GS6) prostate cancer are extremely rare, and that GS6 cancers with nodal metastases are invariably upgraded upon review by academic urological pathologists. We analysed the prevalence and determinants of nodal metastases in a national sample of patients with GS6 cancer.We utilised the SEER database to identify patients diagnosed with GS6 prostate cancer during 2004-2010 who had radical prostatectomy and ≥1 lymph node(s) examined. We calculated the prevalence of nodal metastases and constructed a multivariable logistic regression model to identify factors associated with nodal metastases. Among 21,960 patients, the prevalence of nodal metastases was 0.48%. Older age, preoperative PSA >10 ng/mL, and advanced stage were positively associated with nodal metastases. Lymph node metastases in GS6 cancer are more prevalent in a nationwide population compared to academic centres. Revised guidelines for Gleason scoring have made GS6 cancer a more homogeneously indolent disease, which may be relevant in the era of active surveillance. We submit that lymph node metastases in GS6 cancer be used as a proxy for adherence to the 2005 ISUP consensus on Gleason grading.
基于 2005 年 Gleason 评分的修订，有报道称在根治性前列腺切除术中，Gleason 评分 3+3=6（GS6）前列腺癌的淋巴结转移极为罕见，并且在学术泌尿科病理学家审查时，GS6 癌症的淋巴结转移总是被升级。我们分析了全国 GS6 癌症患者样本中淋巴结转移的患病率和决定因素。我们利用 SEER 数据库确定了 2004 年至 2010 年间诊断为 GS6 前列腺癌且接受根治性前列腺切除术且至少检查了 1 个淋巴结的患者。我们计算了淋巴结转移的患病率，并构建了多变量逻辑回归模型来确定与淋巴结转移相关的因素。在 21960 名患者中，淋巴结转移的患病率为 0.48%。年龄较大、术前 PSA>10ng/mL 和晚期疾病与淋巴结转移呈正相关。与学术中心相比，全国范围内 GS6 癌症的淋巴结转移更为普遍。Gleason 评分修订指南使 GS6 癌症成为一种更同质的惰性疾病，这在主动监测时代可能具有相关性。我们提出，GS6 癌症中的淋巴结转移可用作遵守 2005 年 ISUP 关于 Gleason 分级共识的替代指标。
