活检 Gleason 评分 8-10 分的患者根治性前列腺切除术后病理 Gleason 评分降至 6-7 分的预测因素及肿瘤学结局
Predictive Factors and Oncologic Outcome of Downgrade to Pathologic Gleason Score 6⁻7 after Radical Prostatectomy in Patients with Biopsy Gleason Score 8⁻10.
作者信息
Chung Doo Yong, Lee Jong Soo, Goh Hyeok Jun, Koh Dong Hoon, Kim Min Seok, Jang Won Sik, Choi Young Deuk
机构信息
Department of Urology, Inha University School of Medicine, 366 Seohae-daero, Jung-gu, Incheon 22332, Korea.
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
出版信息
J Clin Med. 2019 Mar 30;8(4):438. doi: 10.3390/jcm8040438.
Gleason score (GS) 8⁻10 is associated with adverse outcomes in prostate cancer (PCa). However, biopsy GS (bGS) may be upgraded or downgraded post-radical prostatectomy (RP). We aimed to investigate predictive factors and oncologic outcomes of downgrade to pathologic GS (pGS) 6⁻7 after RP in PCa patients with bGSs 8⁻10. We retrospectively reviewed clinical data of patients with bGS ≥ 8 undergoing RP. pGS downgrade was defined as a pGS ≤ 7 from bGS ≥ 8 post-RP. Univariate and multivariate cox regression analysis, logistic regression analysis, and Kaplan⁻Meier curves were used to analyze pGS downgrade and biochemical recurrence (BCR). Of 860 patients, 623 and 237 had bGS 8 and bGS ≥ 9, respectively. Post-RP, 332 patients were downgraded to pGS ≤ 7; of these, 284 and 48 had bGS 8 and bGS ≥ 9, respectively. Prostate-specific antigen (PSA) levels; clinical stage; and adverse pathologic features such as extracapsular extension, seminal vesicle invasion and positive surgical margin were significantly different between patients with pGS ≤ 7 and pGS ≥ 8. Furthermore, bGS 8 (odds ratio (OR): 0.349, < 0.001), PSA level < 10 ng/mL (OR: 0.634, = 0.004), and ≤cT3a (OR: 0.400, < 0.001) were identified as significant predictors of pGS downgrade. pGS downgrade was a significant positive predictor of BCR following RP in patients with high bGS (vs. pGS 8, hazard radio (HR): 1.699, < 0.001; vs. pGS ≥ 9, HR: 1.765, < 0.001). In addition, the 5-year BCR-free survival rate in patients with pGS downgrade significantly differed from that in patients with bGS 8 and ≥ 9 (52.9% vs. 40.7%, < 0.001). Among patients with bGS ≥ 8, those with bGS 8, PSA level < 10 ng/mL, and ≤cT3a may achieve pGS downgrade after RP. These patients may have fewer adverse pathologic features and show a favorable prognosis; thus we suggest that active treatment is needed in these patients. In addition, patients with high-grade bGS should be managed aggressively, even if they show pGS downgrade.
Gleason评分（GS）8-10与前列腺癌（PCa）的不良预后相关。然而，穿刺活检GS（bGS）在根治性前列腺切除术（RP）后可能会升级或降级。我们旨在研究bGS为8-10的PCa患者RP后降级至病理GS（pGS）6-7的预测因素和肿瘤学结局。我们回顾性分析了接受RP的bGS≥8患者的临床资料。pGS降级定义为RP后bGS≥8而pGS≤7。采用单因素和多因素cox回归分析、逻辑回归分析以及Kaplan-Meier曲线分析pGS降级和生化复发（BCR）情况。860例患者中，623例bGS为8，237例bGS≥9。RP后，332例患者降级至pGS≤7；其中，284例bGS为8，48例bGS≥9。pGS≤7和pGS≥8的患者在前列腺特异性抗原（PSA）水平、临床分期以及包膜外侵犯、精囊侵犯和手术切缘阳性等不良病理特征方面存在显著差异。此外，bGS为8（比值比（OR）：0.349，P<0.001）、PSA水平<10 ng/mL（OR：0.634，P=0.004）以及≤cT3a（OR：0.400，P<0.001）被确定为pGS降级的显著预测因素。pGS降级是高bGS患者RP后BCR的显著阳性预测因素（与pGS为8相比，风险比（HR）：1.699，P<0.001；与pGS≥9相比，HR：1.765，P<0.001）。此外，pGS降级患者的5年无BCR生存率与bGS为8和≥9的患者显著不同（52.9%对40.7%，P<0.001）。在bGS≥8的患者中，bGS为8、PSA水平<10 ng/mL且≤cT3a的患者RP后可能实现pGS降级。这些患者可能具有较少的不良病理特征且预后良好；因此我们建议对这些患者进行积极治疗。此外，即使高分级bGS患者显示pGS降级，也应积极处理。
Zotero 插件