Zuo Q, Zhang F, Huang Y, Ma L L, Lu M, Lu J
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Department of Pathology, Peking University School of Basic Medical Sciences, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2016 Aug 18;48(4):603-606.
To assess the discrepancy between preoperative needle biopsy (NB) Gleason score and pathological specimen Gleason score (GS) after radical prostatectomy, and to explore the risk factors of postoperative upgrading of GS.
We retrospectively evaluated 160 patients who suffered from biopsy proved prostatic carcinoma and performed radical prostatectomy. Age of the patients was 57-82 years, with the average age of 71.6; prebiopsy prostate specific antigen (PSA) was 0.31-40.32 μg/L,with the average PSA of 11.29 μg/L; body mass index (BMI) was 16.41-32.04 kg/m, with the average BMI of 23.63 kg/m; prostate volume (PV) was 9.52-148.46 mL, with the average PV of 40.19 mL. All the patients included in the study had complete information for clinical variables, including age, BMI, prebiopsy PSA level, PV, number of biopsy cores obtained, percentage, clinical stage, and biopsy GS. Grading of NB Gleason score was compared with their corresponding radical prostatectomy specimens, and the discrepancy between the NB and prostatectomy specimens GS assessed. Upgrading was defined as any increase in the pathological GS over that of the biopsy GS as a total sum of primary and secondary grades or a change in the order of primary and secondary grades towards higher ones. Univariable and multivariable Logistic regression analyses were used to identify predictors of pathological grading changes.
Of the 160 patients, the specimen GS was upgraded in 49 (30.6%) patients and remained with no change in 82 (51.3%) patients. Univariate and multivariate regression analysis showed that prostate volume and biopsy GS were independent predictors with postoperative upgrading of GS. Age, BMI, PSA before needle biopsy, clinical stage and needle number showed no statistical significance (P>0.05).
Lower biopsy GS and smaller prostate volume are increased risks for clinically upgrading of GS after radical prostatectomy. This fact should be kept in mind when deciding on therapy decisions for patients with prostate cancer.
评估根治性前列腺切除术后术前穿刺活检（NB）Gleason评分与病理标本Gleason评分（GS）之间的差异，并探讨GS术后升级的危险因素。
我们回顾性评估了160例经活检证实患有前列腺癌并接受根治性前列腺切除术的患者。患者年龄为57 - 82岁，平均年龄71.6岁；活检前前列腺特异性抗原（PSA）为0.31 - 40.32μg/L，平均PSA为11.29μg/L；体重指数（BMI）为16.41 - 32.04kg/m²，平均BMI为23.63kg/m²；前列腺体积（PV）为9.52 - 148.46mL，平均PV为40.19mL。纳入研究的所有患者均有完整的临床变量信息，包括年龄、BMI、活检前PSA水平、PV、获取的活检芯数量、百分比、临床分期和活检GS。将NB Gleason评分分级与其相应的根治性前列腺切除标本进行比较，并评估NB和前列腺切除标本GS之间的差异。升级定义为病理GS相对于活检GS在主要和次要分级总和上的任何增加，或主要和次要分级顺序向更高等级的变化。采用单变量和多变量Logistic回归分析来确定病理分级变化的预测因素。
160例患者中，49例（30.6%）患者的标本GS升级；82例（51.3%）患者的标本GS无变化。单因素和多因素回归分析显示，前列腺体积和活检GS是GS术后升级的独立预测因素。年龄、BMI、穿刺活检前PSA、临床分期和穿刺针数无统计学意义（P>0.05）。
较低的活检GS和较小的前列腺体积是根治性前列腺切除术后GS临床升级的风险增加因素。在为前列腺癌患者决定治疗方案时应牢记这一事实。
