Jo Jung Ki, Hong Sung Kyu, Byun Seok-Soo, Lee Sang Eun, Lee Sangchul, Oh Jong Jin
Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
Clin Genitourin Cancer. 2016 Aug;14(4):e329-33. doi: 10.1016/j.clgc.2016.01.001. Epub 2016 Jan 22.
We identify the biochemical outcome according to biopsy Gleason score (bGS) among patients who are clinical candidate for active surveillance. We found that different adverse pathologic outcomes and biochemical outcomes were shown according to biopsy pattern although the patients have the same pathologic Gleason score (pGS) 3+4 after RP.
To identify the biochemical recurrence rate (BCR) according to a pGS upgrade after radical prostatectomy among men with prostate cancer who are clinical candidates for active surveillance (AS) according to the Royal Marsden Hospital criteria.
Of the 956 patients with prostate cancer who met the Royal Marsden Hospital criteria for AS underwent radical prostatectomy between January 2006 and June 2014, we enrolled the 830 patients whose pGS was ≤ 3+4 in analysis. We stratified the patients into 3 groups according to the disparity between the bGS and pGS, as follows: group A (n = 211): bGS 3+3 to pGS 3+3; group B (n = 430): bGS 3+3 to pGS 3+4; group C (n = 189): bGS 3+4 to pGS 3+4.
The patients in group C had a higher preoperative prostate-specific antigen level, a higher percentage of positive cores, maximum core involvement (P < .001), and higher postoperative levels of extracapsular extension, seminal vesicle invasion, and positive surgical margins compared with the patients in groups A and B (P < .001, P = .002, and P < .001, for patients in groups C, B, and A, respectively). Group C had a significantly lower BCR-free survival rate compared with groups A and B via Kaplan-Meier, and no difference was observed in the BCR between groups A and B (log rank, P = .475).
Although the patients with the same pGS 3+4 after RP, different adverse outcomes were observed. Because of the significantly different prognosis based on the presence of Gleason pattern 4, patients with this pattern are not suitable for AS.
我们在临床适合积极监测的患者中，根据活检Gleason评分（bGS）确定生化结果。我们发现，尽管患者在根治性前列腺切除术后的病理Gleason评分（pGS）均为3+4，但根据活检模式显示出不同的不良病理结果和生化结果。
根据皇家马斯登医院标准，在临床适合积极监测（AS）的前列腺癌男性患者中，根据根治性前列腺切除术后pGS升级情况确定生化复发率（BCR）。
在2006年1月至2014年6月期间，956例符合皇家马斯登医院AS标准的前列腺癌患者接受了根治性前列腺切除术，我们纳入了830例pGS≤3+4的患者进行分析。根据bGS和pGS之间的差异，将患者分为3组，如下：A组（n = 211）：bGS 3+3至pGS 3+3；B组（n = 430）：bGS 3+3至pGS 3+4；C组（n = 189）：bGS 3+4至pGS 3+4。
与A组和B组患者相比，C组患者术前前列腺特异性抗原水平更高，阳性核心百分比更高，最大核心受累情况更严重（P <.001），术后包膜外侵犯、精囊侵犯和手术切缘阳性水平更高（分别为C组、B组和A组患者，P <.001、P =.002和P <.001）。通过Kaplan-Meier分析，C组的无BCR生存率明显低于A组和B组，A组和B组之间的BCR无差异（对数秩检验，P =.475）。
尽管患者在根治性前列腺切除术后的pGS均为3+4，但观察到不同的不良结果。由于基于Gleason模式4的存在，预后存在显著差异，具有这种模式的患者不适合进行积极监测。
