van Leeuwen Pim J, Siriwardana Amila, Roobol Monique, Ting Francis, Nieboer Daan, Thompson James, Delprado Warick, Haynes Anne-Marie, Brenner Phillip, Stricker Phillip
St Vincent's Prostate Cancer Centre, St Vincent's Clinic, Sydney, NSW 2010, Australia; Australian Prostate Cancer Research Centre New South Wales, The Garvan Institute of Medical Research, The Kinghorn Cancer Centre, Sydney, NSW 2010, Australia.
St Vincent's Prostate Cancer Centre, St Vincent's Clinic, Sydney, NSW 2010, Australia; Australian Prostate Cancer Research Centre New South Wales, The Garvan Institute of Medical Research, The Kinghorn Cancer Centre, Sydney, NSW 2010, Australia; University of New South Wales, Sydney, NSW 2052, Australia.
Prostate Cancer. 2016;2016:7105678. doi: 10.1155/2016/7105678. Epub 2016 Apr 11.
Introduction. To assess the performance of five previously described clinicopathological definitions of low-risk prostate cancer (PC). Materials and Methods. Men who underwent radical prostatectomy (RP) for clinical stage ≤T2, PSA <10 ng/mL, Gleason score <8 PC, diagnosed by transperineal template-guided saturation biopsy were included. The performance of five previously described criteria (i.e., criteria 1-5, criterion 1 stringent (Gleason score 6 + ≤5 mm total max core length PC + ≤3 mm max per core length PC) up to criterion 5 less stringent (Gleason score 6-7 with ≤5% Gleason grade 4) was analysed to assess ability of each to predict insignificant disease in RP specimens (defined as Gleason score ≤6 and total tumour volume <2.5 mL, or Gleason score 7 with ≤5% grade 4 and total tumour volume <0.7 mL). Results. 994 men who underwent RP were included. Criterion 4 (Gleason score 6) performed best with area under the curve of receiver operating characteristics 0.792. At decision curve analysis, criterion 4 was deemed clinically the best performing transperineal saturation biopsy-based definition for low-risk PC. Conclusions. Gleason score 6 disease demonstrated a superior trade-off between sensitivity and specificity for clarifying low-risk PC that can guide treatment and be used as reference test in diagnostic studies.
引言。评估先前描述的五种低风险前列腺癌（PC）临床病理定义的性能。材料与方法。纳入经会阴模板引导下饱和穿刺活检诊断为临床分期≤T2、PSA<10 ng/mL、Gleason评分<8的PC且接受根治性前列腺切除术（RP）的男性。分析了先前描述的五种标准（即标准1 - 5，标准1最严格（Gleason评分6 + 总最大核心长度PC≤5 mm + 每核心最大长度PC≤3 mm）至标准5较宽松（Gleason评分6 - 7且Gleason 4级≤5%））的性能，以评估每种标准预测RP标本中无意义疾病的能力（定义为Gleason评分≤6且肿瘤总体积<2.5 mL，或Gleason评分7且4级≤5%且肿瘤总体积<0.7 mL）。结果。纳入994例行RP的男性。标准4（Gleason评分6）表现最佳，受试者操作特征曲线下面积为0.792。在决策曲线分析中，标准4被认为是基于经会阴饱和穿刺活检的低风险PC临床最佳性能定义。结论。Gleason评分6的疾病在明确低风险PC的敏感性和特异性之间表现出更好的权衡，可指导治疗并用作诊断研究中的参考测试。
