Department of Urology, SMG-SNU Boramae Medical Center, College of Medicine, Seoul National University, Seoul, Republic of Korea.
Department of Urology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea.
Urol Int. 2020;104(3-4):199-204. doi: 10.1159/000503888. Epub 2019 Nov 6.
The aim of this study was to evaluate the feasibility of including patients with biopsy Gleason score (bGS) 3 + 4 prostate cancer in an active surveillance (AS) protocol.
A total of 615 patients underwent a radical prostatectomy and satisfied the following requirements: prostate-specific antigen ≤10 ng/dL, clinical stage T1c or T2a, 2 or fewer positive biopsy cores, and bGS 6 or 3 + 4 prostate cancer. The patients were divided into two groups according to their bGS (bGS 6 group, n =534; bGS 3 + 4 group, n = 81).
The adverse pathological features were significantly higher in the bGS 3 + 4 group (16.7 vs. 49.4%, p< 0.001). Biochemical recurrence (BCR)-free survival was also significantly lower in this group (p < 0.001). In a multivariate analysis, clinical stage (odds ratio [OR] 2.026, p =0.007), maximum percentage of biopsy core involvement (OR 1.015, p = 0.014), and bGS (OR 1.913, p = 0.030) were independent risk factors for adverse pathological features. However, the bGS was the only variable to forecast BCR (hazard ratio 3.567, p < 0.001).
A bGS 3 + 4 was the leading risk factor for a worse postoperative prognosis. Therefore, patients with a bGS 3 + 4 are not appropriate candidates for AS.
本研究旨在评估将活检 Gleason 评分（bGS）3+4 前列腺癌患者纳入主动监测（AS）方案的可行性。
共有 615 例患者接受了根治性前列腺切除术，且符合以下要求：前列腺特异性抗原（PSA）≤10ng/dL、临床分期 T1c 或 T2a、2 个或更少的阳性活检核心以及 bGS 6 或 3+4 前列腺癌。患者根据 bGS 分为两组（bGS 6 组，n=534；bGS 3+4 组，n=81）。
bGS 3+4 组的不良病理特征显著更高（16.7%比 49.4%，p<0.001）。该组的生化复发（BCR）无复发生存率也显著较低（p<0.001）。在多变量分析中，临床分期（比值比[OR]2.026，p=0.007）、最大活检核心受累百分比（OR 1.015，p=0.014）和 bGS（OR 1.913，p=0.030）是不良病理特征的独立危险因素。然而，bGS 是唯一预测 BCR 的变量（风险比 3.567，p<0.001）。
bGS 3+4 是术后预后较差的主要危险因素。因此，bGS 3+4 患者不适合进行 AS。
