Department of Urology, University of Illinois at Chicago, Chicago, IL, USA.
Department of Urology, Queen's University, Kingston, ON, Canada.
BJU Int. 2019 Jan;123(1):91-97. doi: 10.1111/bju.14428. Epub 2018 Jul 26.
To evaluate the association between acute and chronic inflammation with the presence of perineural invasion (PNI) in prostate biopsies positive for prostate cancer (PCa).
We conducted a retrospective analysis of 1 399 prostate biopsies positive for PCa in the Reduction by Dutasteride of PCa Events (REDUCE) study. PCa, acute and chronic prostate inflammation and PNI were assessed by central pathology review. The association between acute and chronic inflammation with PNI was evaluated using chi-squared and Kruskal-Wallis tests, and logistic regression adjusting for clinicopathological and biochemical variables.
The presence of PNI was identified in 133 biopsies (9.5%). In all, 267 biopsies (19.1%) had acute inflammation, 1 038 (74.2%) had chronic inflammation, and 255 (18.2%) had both. The presence of both acute and chronic inflammation had a mutual association (P < 0.001). Chronic inflammation was associated with a lower Gleason score (P = 0.009) and lower tumour volume (P < 0.001), while acute inflammation was associated with lower Gleason score (P = 0.04), lower tumour volume (P = 0.004) and higher prostate-specific antigen levels (P = 0.05). In both univariable and multivariable analyses, chronic prostate inflammation was significantly associated with less PNI (univariable odds ratio [OR] 0.54, 95% confidence interval [CI] 0.37-0.79, P = 0.001; multivariable OR 0.65, 95% CI 0.43-0.99, P = 0.045). Acute prostate inflammation was associated with less PNI only in univariable analysis (univariable OR 0.51, 95% CI 0.29-0.89, P = 0.018; multivariable OR 0.63, 95% CI 0.35-1.13, P = 0.12).
Acute and chronic prostate inflammation were both associated with a lower prevalence of PNI in prostate biopsies positive for PCa. If confirmed, this suggests that inflammation and immunomodulation can serve as areas of potential therapeutic design to mitigate PNI in patients with PCa.
评估急性和慢性炎症与前列腺癌（PCa）阳性前列腺活检中神经周围侵犯（PNI）的相关性。
我们对 REDUCE 研究中 1399 例 PCa 阳性前列腺活检进行了回顾性分析。通过中心病理复查评估 PCa、急性和慢性前列腺炎症以及 PNI。使用卡方检验和 Kruskal-Wallis 检验评估急性和慢性炎症与 PNI 之间的相关性，并通过调整临床病理和生化变量进行 logistic 回归分析。
133 例活检（9.5%）中发现有 PNI。共有 267 例活检（19.1%）有急性炎症，1038 例（74.2%）有慢性炎症，255 例（18.2%）两者都有。急性和慢性炎症的存在存在相互关联（P<0.001）。慢性炎症与较低的 Gleason 评分（P=0.009）和较低的肿瘤体积（P<0.001）相关，而急性炎症与较低的 Gleason 评分（P=0.04）、较低的肿瘤体积（P=0.004）和较高的前列腺特异性抗原水平（P=0.05）相关。在单变量和多变量分析中，慢性前列腺炎症与较少的 PNI 显著相关（单变量优势比 [OR] 0.54，95%置信区间 [CI] 0.37-0.79，P=0.001；多变量 OR 0.65，95%CI 0.43-0.99，P=0.045）。急性前列腺炎症仅在单变量分析中与较少的 PNI 相关（单变量 OR 0.51，95%CI 0.29-0.89，P=0.018；多变量 OR 0.63，95%CI 0.35-1.13，P=0.12）。
急性和慢性前列腺炎症均与 PCa 阳性前列腺活检中 PNI 的发生率较低相关。如果得到证实，这表明炎症和免疫调节可以作为潜在治疗设计的领域，以减轻 PCa 患者的 PNI。
