Bsirini Caroline, Danakas Alexandra M, Miyamoto Hiroshi
Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York.
Department of Urology, University of Rochester Medical Center, Rochester, New York.
Prostate. 2018 Nov;78(15):1166-1171. doi: 10.1002/pros.23691. Epub 2018 Jul 11.
No consensus has been reached for an optimal method of quantifying discontinuous tumor foci separated by intervening benign tissue on prostate biopsy (PBx). We examined sets of PBx, where cancer involved only one core, and corresponding radical prostatectomy (RP) specimens.
Cases were divided into 3 groups-Group 1 (n = 80): <3 mm in end-to-end tumor measurement (continuous/discontinuous); Group 2 (n = 22): ≥3 mm in tumor length (continuous); and Group 3 (n = 15): ≥3 mm in end-to-end tumor measurement (discontinuous). The rate of Gleason score ≥7 was considerably lower in Group 1 (9%/30% on PBx/RP) than in Group 2 (50% [P < 0.001]/59% [P = 0.015] on PBx/RP) or Group 3 (40% [P = 0.005]/46% [P = 0.237] on PBx/RP). pT2 disease was significantly more often found in Group 1 (88%) than in Group 2 (68%, P = 0.049) or Group 3 (60%, P = 0.018). Surgical margin was significantly more often positive in Group 3 (27%) than in Group 1 (5%, P = 0.020), but not Group 2 (9%, P = 0.198). Moreover, estimated cancer volume (cc, mean ± SD) was significantly smaller in Group 1 (1.89 ± 1.98) than in Group 2 (3.56 ± 2.92, P = 0.026) or Group 3 (3.44 ± 2.02, P = 0.013). Kaplan-Meier analysis revealed higher risks of biochemical recurrence after RP in Group 2, compared with Group 1 (P = 0.001) or Group 3 (P = 0.096). In 93 patients with biopsy Gleason score 6 cancer, higher rates of pT2+/3 disease (P = 0.023) and positive margin (P = 0.026), as well as larger cancer volume (P = 0.063), on RP were still seen in Group 3, compared with Group 1, but their differences were not statistically significant between Group 2 and Group 3.
Linear quantitation including intervening benign tissue on PBx may more precisely predict the actual tumor extent.
对于前列腺穿刺活检（PBx）中被良性组织分隔的不连续肿瘤病灶进行量化的最佳方法尚未达成共识。我们研究了仅一个穿刺针芯发现癌症的PBx病例组以及相应的根治性前列腺切除术（RP）标本。
病例分为3组——第1组（n = 80）：肿瘤端到端测量<3 mm（连续/不连续）；第2组（n = 22）：肿瘤长度≥3 mm（连续）；第3组（n = 15）：肿瘤端到端测量≥3 mm（不连续）。第1组中Gleason评分≥7的比例在PBx/RP时分别为9%/30%，显著低于第2组（PBx/RP时分别为50% [P < 0.001]/59% [P = 0.015]）或第3组（PBx/RP时分别为40% [P = 0.005]/46% [P = 0.237]）。第1组中pT2期疾病的发生率（88%）显著高于第2组（68%，P = 0.049）或第3组（60%，P = 0.018）。第3组手术切缘阳性率（27%）显著高于第1组（5%，P = 0.020），但与第2组（9%，P = 0.198）相比无显著差异。此外，第1组的估计癌体积（cc，均值±标准差）（1.89 ± 1.98）显著小于第2组（3.56 ± 2.92，P = 0.026）或第3组（3.44 ± 2.02，P = 0.013）。Kaplan-Meier分析显示，与第1组（P = 0.001）或第3组（P = 0.096）相比，第2组RP后生化复发风险更高。在93例活检Gleason评分为6分的癌症患者中，与第1组相比，第3组在RP时pT2+/3期疾病发生率（P = 0.023）、切缘阳性率（P = 0.026）以及癌体积更大（P = 0.063），但第2组与第3组之间差异无统计学意义。
对PBx中包括中间良性组织进行线性定量可能更精确地预测实际肿瘤范围。
