Department of Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
Department of Radiation Oncology, University of Utah, Salt Lake City, UT, USA.
Cancer Med. 2020 May;9(10):3383-3389. doi: 10.1002/cam4.2920. Epub 2020 Mar 18.
The significance of perineural invasion (PNI) in prostate cancer (PC) is unclear. A recent report of patients with pT2N0R0 PC found that PNI at prostatectomy was independently associated with higher Gleason score and more diffuse prostatic disease. We aimed to test our hypothesis that PNI on prostate biopsy in pT2N0R0 patients is associated with increased Gleason score upgrading at prostatectomy.
We identified 2892 patients status post prostatectomy with pT2N0R0 PC from three institutions, diagnosed between 1 January 2008 and 31 December 2014. Multivariable logistic regression (MVA) was used to evaluate the association between prostate biopsy PNI status and surgical Gleason upgrading, while controlling for potential confounders.
Of the 2892 patients identified, 14% had PNI on biopsy, of whom 21% had surgical Gleason upgrading, while 28% without PNI on biopsy had such upgrading (P < .01). On MVA, the odds ratio (OR) of surgical Gleason upgrading for patients with biopsy PNI relative to patients without biopsy PNI was 0.69 (P < .01). The variables associated with surgical Gleason upgrading were age ≤60 years (OR 1.22, P = .02) and preoperative PSA >4 ng/mL (OR 1.26, P = .02).
In post-prostatectomy patients with favorable-risk PC, PNI on prostate biopsy was not associated with surgical Gleason score upgrading. This may be due to the association of PNI with more diffuse disease, leading to increased biopsy tumor yield and grading accuracy. These findings suggest that in this setting, biopsy PNI alone should not be a concern for more aggressive disease requiring pathologic confirmation or intervention. This may help guide treatment decision-making for men debating active surveillance, radiation, and surgery.
神经周围侵犯（PNI）在前列腺癌（PC）中的意义尚不清楚。最近一项关于 pT2N0R0 PC 患者的报告发现，前列腺切除术时的 PNI 与更高的 Gleason 评分和更弥漫性前列腺疾病独立相关。我们旨在检验我们的假设，即在 pT2N0R0 患者中，前列腺活检上的 PNI 与前列腺切除术后 Gleason 评分升级相关。
我们从三个机构确定了 2892 例 pT2N0R0 PC 前列腺切除术后患者，这些患者的诊断时间在 2008 年 1 月 1 日至 2014 年 12 月 31 日之间。使用多变量逻辑回归（MVA）来评估前列腺活检 PNI 状态与手术 Gleason 升级之间的关联，同时控制潜在的混杂因素。
在所确定的 2892 例患者中，14%的患者在活检时存在 PNI，其中 21%的患者有手术 Gleason 升级，而 28%的患者在活检时没有 PNI 但存在升级（P<.01）。在 MVA 中，相对于没有活检 PNI 的患者，活检时存在 PNI 的患者发生手术 Gleason 升级的比值比（OR）为 0.69（P<.01）。与手术 Gleason 升级相关的变量为年龄≤60 岁（OR 1.22，P=.02）和术前 PSA>4ng/mL（OR 1.26，P=.02）。
在前列腺切除术后具有有利风险的 PC 患者中，前列腺活检上的 PNI 与手术 Gleason 评分升级无关。这可能是由于 PNI 与更弥漫性疾病相关，导致活检肿瘤产量和分级准确性增加。这些发现表明，在这种情况下，单独的活检 PNI 不应该被认为是需要病理证实或干预的更具侵袭性疾病的担忧。这可能有助于指导正在考虑主动监测、放疗和手术的男性的治疗决策。
