Porcaro Antonio B, Siracusano Salvatore, de Luyk Nicolò, Corsi Paolo, Sebben Marco, Tafuri Alessandro, Mattevi Daniele, Bizzotto Leonardo, Tamanini Irene, Cerruto Maria A, Martignoni Guido, Brunelli Matteo, Artibani Walter
Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Department of Patholog, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Curr Urol. 2017 Aug;10(3):118-125. doi: 10.1159/000447164. Epub 2017 Jul 30.
To identify significant clinical factors associated with prostate cancer (PCa) upgrading the low-risk PCa patients graded according to the modified Gleason score system.
The logistic regression model was used to evaluate the records of 438 patients.
There were 170 cases (38.8%) of low-risk PCa and tumors were upgraded in 111 patients (65.3%). Only prostate specific antigen (PSA) and the proportion of positive cores (P+) were independent predictors of tumor upgrading. Further exploration was investigated by categorizing and regressing PSA (≤ 5.0 vs. > 5.0 ng/ml) and P+ (≤ 0.20 vs. > 0.20). The odds ratio of PSA > 5 ng/ml was 1.32 and of P+ > 0.20 was 2.71. The population was stratified into very low-risk with PSA ≤ 5 ng/ml and P+ ≤ 0.20 (class A), low-risk with PSA > 5 ng/ml and P+ ≤ 0.20 (class B), intermediate risk with PSA ≤ 5 ng/ml and P+ > 0.20 (class C), and high risk with PSA > 5 ng/ml and P+ 0.20 (class D). Upgrading rates were extremely low in class A (9%), extremely high in D (50.5%), and moderate (20%) in B and C.
Patients diagnosed with low-risk PCa at biopsy are a heterogeneous population because they include subsets with undetected high-grade disease. Significant clinical predictors of upgrading include the PSA value and P+. In low-risk PCa, we identified a high-risk upgrading subgroup that needed repeat biopsies in order to reclassify the tumor grade and to reassess the clinical risk category.
确定与根据改良 Gleason 评分系统分级的低风险前列腺癌（PCa）患者肿瘤升级相关的重要临床因素。
采用逻辑回归模型评估 438 例患者的记录。
低风险 PCa 患者 170 例（38.8%），其中 111 例（65.3%）肿瘤发生升级。仅前列腺特异性抗原（PSA）和阳性核心比例（P+）是肿瘤升级的独立预测因素。通过对 PSA（≤5.0 与>5.0 ng/ml）和 P+（≤0.20 与>0.20）进行分类和回归进一步探索。PSA>5 ng/ml 的优势比为 1.32，P+>0.20 的优势比为 2.71。将人群分为 PSA≤5 ng/ml 且 P+≤0.20 的极低风险组（A 类）、PSA>5 ng/ml 且 P+≤0.20 的低风险组（B 类）、PSA≤5 ng/ml 且 P+>0.20 的中度风险组（C 类）以及 PSA>5 ng/ml 且 P+>0.20 的高风险组（D 类）。A 类升级率极低（9%），D 类极高（50.5%），B 类和 C 类为中度（20%）。
活检诊断为低风险 PCa 的患者是一个异质性群体，因为他们包括未检测到的高级别疾病亚组。升级的重要临床预测因素包括 PSA 值和 P+。在低风险 PCa 中，我们确定了一个高风险升级亚组，需要重复活检以重新分类肿瘤分级并重新评估临床风险类别。
