Valette Thiago N, Antunes Alberto A, Leite Katia Moreira, Srougi Miguel
Division of Urology, University of São Paulo Medical School, São Paulo, Brazil.
Int Braz J Urol. 2015 May-Jun;41(3):449-54. doi: 10.1590/S1677-5538.IBJU.2014.0223.
Prediction of extraprostatic disease in clinically localized prostate cancer is relevant for treatment planning of the disease. The purpose of this study was to explore the usefulness of the percentage of positive biopsy cores to predict the chance of extraprostatic cancer.
We evaluated 1787 patients with localized prostate cancer submitted to radical prostatectomy. The percentage of positive cores in prostate biopsy was correlated with the pathologic outcome of the surgical specimen. In the final analysis, a correlation was made between categorical ranges of positive cores (10% intervals) and the risk of extraprostatic extension and/or bladder neck invasion, seminal vesicles involvement or metastasis to iliac lymph nodes. Student's t test was used for statistical analysis.
For each 10% of positive cores we observed a progressive higher prevalence of extraprostatic disease. The risk of cancer beyond the prostate capsule for <10% positive biopsy cores was 7.4% and it increased to 76.2% at the category 90-100% positive cores. In patients with Gleason grade 4 or 5, the risk of extraprostatic cancer prostate was higher than in those without any component 4 or 5.
The percentage of positive cores in prostate biopsy can predict the risk of cancer outside the prostate. Our study shows that the percentage of positive prostate biopsy fragments helps predict the chance of extraprostatic cancer and may have a relevant role in the patient's management.
预测临床局限性前列腺癌的前列腺外疾病对于该疾病的治疗规划具有重要意义。本研究的目的是探讨阳性活检核心百分比预测前列腺外癌发生几率的实用性。
我们评估了1787例接受根治性前列腺切除术的局限性前列腺癌患者。前列腺活检中阳性核心的百分比与手术标本的病理结果相关。在最终分析中，对阳性核心的分类范围（以10%为间隔）与前列腺外扩展和/或膀胱颈侵犯、精囊受累或髂淋巴结转移的风险进行了相关性分析。采用Student's t检验进行统计学分析。
每增加10%的阳性核心，我们观察到前列腺外疾病的患病率逐渐升高。活检阳性核心<10%时，前列腺包膜外癌的风险为7.4%，而在阳性核心为90%-100%的类别中，该风险增加到76.2%。在Gleason分级为4或5级的患者中，前列腺外癌的风险高于无任何4级或5级成分的患者。
前列腺活检中阳性核心的百分比可预测前列腺外癌的风险。我们的研究表明，前列腺活检阳性碎片的百分比有助于预测前列腺外癌的发生几率，并且可能在患者管理中发挥重要作用。
