Department of Pathology, University of Foggia, Foggia, Italy.
Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy; Department of Urology, Icahn school of medicine at Mount Sinai, New York City, NY.
Urol Oncol. 2020 Oct;38(10):793.e19-793.e25. doi: 10.1016/j.urolonc.2020.02.025. Epub 2020 Mar 25.
To determine the potential role of bioptic inflammation (Irani score) in predicting adverse pathology (AP) at radical prostatectomy (RP) in patients with low-grade (ISUP Gleason Group [ISUP GG] 1 and 2) prostate cancer (CaP).
After institutional review board-approval, we identified patients who underwent prostate biopsy, had bioptic Irani score assessment, were diagnosed with low-grade CaP (ISUP GG 1-2, prostate-specific antigen [PSA] <20 ng/ml), and underwent RP. The impact of standard clinicopathological variables and bioptic Irani Score (G = grade and A = aggressiveness) on AP at RP, defined as stage ≥T3 and/or ISUP GG ≥3, was assessed by univariate and multivariate logistic regression analysis.
A total of 282 patients were eligible for this study. AP at RP occurred in 37 of 214 (17.3%) patients with ISUP GG 1, and 26 of 68 (38.2%) with ISUP GG 2. At univariate analysis, serum PSA, PSA density, bioptic ISUP GG, number of positive cores, total percentage of core involvement and Irani G score emerged as significant risk factors of AP. At multivariate analysis, however, only PSA density, bioptic ISUP GG, total percentage of core, and Irani G score kept statistical significance. The area under the curve for the resulting model was 0.75.
This is the first study demonstrating that low-grade inflammation is associated with a significantly increased risk of AP at RP. These findings would support the concept of prostatic inflammation being inversely correlated with presence and aggressiveness of CaP. Further studies are needed to externally validate the role of this readily available parameter in the decision-making process of patients with low-grade CaP.
确定活检炎症（Irani 评分）在预测低级别前列腺癌（ISUP 格里森组 [ISUP GG] 1 和 2）患者根治性前列腺切除术（RP）中不良病理（AP）方面的潜在作用。
在获得机构审查委员会批准后，我们确定了接受前列腺活检、Irani 评分评估、诊断为低级别 CaP（ISUP GG 1-2，前列腺特异性抗原 [PSA] <20ng/ml）并接受 RP 的患者。通过单变量和多变量逻辑回归分析评估标准临床病理变量和活检 Irani 评分（G=分级和 A=侵袭性）对 RP 中 AP 的影响，AP 定义为≥T3 期和/或 ISUP GG≥3 期。
共有 282 名患者符合本研究条件。在 ISUP GG 1 组的 214 名患者中，有 37 名（17.3%）患者发生 RP 时发生 AP，在 ISUP GG 2 组的 68 名患者中有 26 名（38.2%）发生 AP。在单变量分析中，血清 PSA、PSA 密度、活检 ISUP GG、阳性核心数、核心受累的总百分比和 Irani G 评分是 AP 的显著危险因素。然而，在多变量分析中，只有 PSA 密度、活检 ISUP GG、核心受累的总百分比和 Irani G 评分具有统计学意义。由此产生的模型的曲线下面积为 0.75。
这是第一项表明低级别炎症与 RP 时 AP 风险显著增加相关的研究。这些发现将支持前列腺炎症与 CaP 的存在和侵袭性呈负相关的概念。需要进一步研究来验证该易于获得的参数在低级别 CaP 患者决策过程中的作用。
