Maruyama Yuki, Sadahira Takuya, Araki Motoo, Mitsui Yosuke, Wada Koichiro, Rodrigo Acosta Gonzalez Herik, Munetomo Kazuaki, Kobayashi Yasuyuki, Watanabe Masami, Yanai Hiroyuki, Watanabe Toyohiko, Nasu Yasutomo
Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
Mol Clin Oncol. 2020 Apr;12(4):384-389. doi: 10.3892/mco.2020.1996. Epub 2020 Feb 10.
The present study investigated the concordance between Gleason scores assigned to prostate biopsy specimens by outside pathologists and a urological pathology expert, and determined the risk of upgrading between opinion-matched Gleason grade group (GGG) 1 biopsy specimens and radical prostatectomy specimens. Between January 2012 and May 2018, 733 patients underwent robot-assisted radical prostatectomy. Patients whose original biopsy specimens from outside hospitals were reviewed by a urological pathology expert Okayama University Hospital were included. Patients who had received neoadjuvant hormonal therapy were excluded. Logistic regression analysis was used to identify predictors of upgrading among GGG 1 diagnoses. A total of 403 patients were included in the present study. Agreement in GGG between initial and second-opinion diagnoses was present in 256 cases (63.5%). Although opinion-matched cases improved concordance between biopsy and prostatectomy specimen GGG compared with single-opinion cases (initial, 35.2%; second-opinion, 36.5%; matched, 41.4%), 71% (56/79) of cases classified as GGG 1 were upgraded after prostatectomy. Multivariate analysis revealed that prostate-specific antigen density and Prostate Imaging Reporting and Data System version 2 score were significant predictors of upgrading (odds ratio, 1.10; P=0.01; and odds ratio, 1.88; P=0.03, respectively). In conclusion, the GGG concordance rate between needle-core biopsy and radical prostatectomy specimens was higher in opinion-matched cases; however, 71% of opinion-matched GGG1 cases were upgraded after robot-assisted radical prostatectomy. Urologists should propose treatment strategies or further biopsy rather than active surveillance for patients with GGG1 and a high PSAD and/or PI-RADS score.
本研究调查了外部病理学家与泌尿外科病理专家对前列腺活检标本所指定的Gleason评分之间的一致性，并确定了意见匹配的Gleason分级组（GGG）1活检标本与根治性前列腺切除术标本之间升级的风险。在2012年1月至2018年5月期间，733例患者接受了机器人辅助根治性前列腺切除术。纳入了来自冈山大学医院泌尿外科病理专家对外部医院原始活检标本进行复查的患者。排除接受过新辅助激素治疗的患者。采用逻辑回归分析来确定GGG 1诊断中升级的预测因素。本研究共纳入403例患者。初始诊断与二次诊断之间GGG的一致性在256例（63.5%）中存在。尽管与单一意见病例相比，意见匹配病例改善了活检与前列腺切除术标本GGG之间的一致性（初始诊断，35.2%；二次诊断，36.5%；匹配，41.4%），但在前列腺切除术后，71%（56/79）被分类为GGG 1的病例出现了升级。多变量分析显示，前列腺特异性抗原密度和前列腺影像报告和数据系统第2版评分是升级的显著预测因素（优势比分别为1.10；P = 0.01；以及优势比为1.88；P = 0.03）。总之，在意见匹配的病例中，针芯活检与根治性前列腺切除术标本之间的GGG一致性率更高；然而，71%意见匹配的GGG1病例在机器人辅助根治性前列腺切除术后出现了升级。泌尿外科医生应为GGG1且前列腺特异性抗原密度高和/或PI-RADS评分高的患者提出治疗策略或进一步活检，而不是主动监测。
