广泛高级别前列腺上皮内瘤变和不典型小腺泡增生的自然史：我们是否应该对它们全部重新活检？

Natural history of widespread high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation: should we rebiopsy them all?

机构信息

Division of Urology, Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy.

Division of Pathology, Città della Salute e della Scienza - Molinette Hospital, Turin, Italy.

出版信息

Scand J Urol. 2021 Apr;55(2):129-134. doi: 10.1080/21681805.2020.1866659. Epub 2021 Jan 7.

DOI:10.1080/21681805.2020.1866659

PMID:33410348

Abstract

OBJECTIVE

To evaluate the premalignant potential of high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP).

METHODS

Patients diagnosed with monofocal HGPIN (mHGPIN), widespread HGPIN (≥4 cores, wHGPIN) and/or ASAP who underwent at least one rebiopsy during their follow-up, were enrolled. All enrollment biopsies underwent central pathologic revision. Risks for PCa were estimated using Fine and Gray method for competing risk.

RESULTS

Pathologic revision changed the original diagnosis in 32.3% of cases. Among 336 cases enrolled, PCa was diagnosed in 164 (48.8%), and more specifically in 20 (30.3%) mHGPIN, 10 (34.5%) wHGPIN, 101 (54.0%) ASAP, and 33 (61.1%) HGPIN + ASAP (mean follow-up 124 months). Most PCa were Gleason score 6(3 + 3) (51.0%) and 7(3 + 4) (34.3%). On multivariate analysis, HGPIN + ASAP (HR 2.76, < 0.001) and ASAP alone (HR 2.41, < 0.001) were the only lesions significantly associated with PCa development. Of all cancers detected, 64.3% were at first rebiopsy. A rebiopsy performed within 3 months after ASAP diagnosis had a 45% chance of finding PCa. At Kaplan-Meier survival curves, median PCa-free survival was 48.1 months for HGPIN + ASAP and 64.9 months for ASAP ( 0.0005 at Log-rank test). At 1 year, 70% of HGPIN + ASAP, 73% of ASAP, 89% of wHGPIN, and 84% of mHGPIN were PCa-free.

CONCLUSION

The diagnosis of ASAP and HGPIN strongly relies on the expertise of dedicated uro-pathologists. Finding of ASAP is a strong risk factor for a subsequent PCa diagnosis, advising a rebiopsy, possibly within 3 months. m/wHGPIN should not be routinely rebiopsied.

摘要

目的

评估高级别前列腺上皮内瘤变（HGPIN）和非典型小腺泡增生（ASAP）的癌前潜能。

方法

本研究纳入了诊断为单灶 HGPIN（mHGPIN）、广泛 HGPIN（≥4 个核心，wHGPIN）和/或 ASAP 且在随访期间至少接受过一次再次活检的患者。所有入组活检均进行中心病理复查。使用 Fine 和 Gray 法对竞争风险进行估计，以评估前列腺癌的风险。

结果

病理复查改变了 32.3%病例的原始诊断。在 336 例入组患者中，诊断为前列腺癌的有 164 例（48.8%），具体为 20 例 mHGPIN（30.3%）、10 例 wHGPIN（34.5%）、101 例 ASAP（54.0%）和 33 例 HGPIN+ASAP（平均随访 124 个月）。大多数前列腺癌为 Gleason 评分 6（3+3）（51.0%）和 7（3+4）（34.3%）。多变量分析显示，HGPIN+ASAP（HR 2.76，<0.001）和 ASAP 单独存在（HR 2.41，<0.001）是与前列腺癌发展唯一显著相关的病变。在所有检测到的癌症中，64.3%在第一次再次活检时发现。在 ASAP 诊断后 3 个月内进行再次活检，有 45%的机会发现前列腺癌。在 Kaplan-Meier 生存曲线中，HGPIN+ASAP 的中位无前列腺癌生存时间为 48.1 个月，ASAP 为 64.9 个月（Log-rank 检验 P=0.0005）。在 1 年时，HGPIN+ASAP 的无前列腺癌率为 70%，ASAP 为 73%，wHGPIN 为 89%，mHGPIN 为 84%。