Ahmad Amar S, Parameshwaran Vishnu, Beltran Luis, Fisher Gabrielle, North Bernard V, Greenberg David, Soosay Geraldine, Møller Henrik, Scardino Peter, Cuzick Jack, Berney Daniel M
UK Center for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
Department of Molecular Oncology, Barts Cancer Institute Queen Mary University of London, London, UK.
Oncotarget. 2018 Apr 17;9(29):20555-20562. doi: 10.18632/oncotarget.24994.
The identification of perineural invasion (PNI) and extraprostatic extension (ECE) in prostate cancer (PC) biopsies is time consuming and can be difficult. Although this is required information in many datasets, there is little evidence on their effect on outcome in patients treated conservatively. Cases of PC were identified from three cancer registries in the UK from men with clinically localized prostate cancer diagnosed by needle biopsy from 1990-2003. The endpoint was prostate cancer death (DOD). Patients treated radically within 6 months, those with objective evidence of metastases or who had prior hormone therapy were excluded. Follow-up was through cancer registries up until 2012. Deaths were divided into those from PC and those from other causes, according to WHO criteria. 988 biopsy cases (6522 biopsy cores) were centrally reviewed by three uropathologists and assigned a Gleason score and Grade Group (GG). The presence of both PNI and ECE was recorded. Of 988 patients, PNI was present in 288 (DOD = 75) and ECE in 23 (DOD = 5). On univariable analysis PNI was highly significantly associated with DOD (hazard ratio [HR] 2.28, 95% CI: 1.68, 3.1, log-rank test -value = 4.8 × 10), but ECE was not (log-rank test -value = 0.334). On multivariable analysis with GG, serum PSA (per 10%), clinical stage and extent of disease (per 10%), PNI lost significance (HR 1.16, 95% CI: 0.83, 1.63, likelihood ratio test -value = 0.371). The utility of routinely examining prostate biopsies for ECE and PNI is doubtful as it is not independently associated with higher grade, stage or prognosis.
在前列腺癌（PC）活检中识别神经周围浸润（PNI）和前列腺外扩展（ECE）既耗时又困难。尽管在许多数据集中这是必需的信息，但关于它们对保守治疗患者预后的影响，几乎没有证据。从英国三个癌症登记处识别出PC病例，这些病例来自1990年至2003年经针吸活检诊断为临床局限性前列腺癌的男性。终点是前列腺癌死亡（DOD）。排除在6个月内接受根治性治疗的患者、有转移客观证据的患者或曾接受过激素治疗的患者。通过癌症登记处进行随访直至2012年。根据世界卫生组织标准，死亡分为前列腺癌死亡和其他原因死亡。988例活检病例（6522个活检核心）由三位泌尿病理学家进行集中审查，并给出Gleason评分和分级组（GG）。记录PNI和ECE的存在情况。在988例患者中，288例存在PNI（DOD = 75），23例存在ECE（DOD = 5）。单变量分析显示，PNI与DOD高度显著相关（风险比[HR] 2.28，95%置信区间：1.68，3.1，对数秩检验P值 = 4.8×10），但ECE并非如此（对数秩检验P值 = 0.334）。在对GG、血清PSA（每10%）、临床分期和疾病范围（每10%）进行多变量分析时，PNI失去了显著性（HR 1.16，95%置信区间：0.83，1.63，似然比检验P值 = 0.371）。常规检查前列腺活检中的ECE和PNI的实用性存疑，因为它与更高的分级、分期或预后并无独立关联。
