前列腺癌患者行机器人辅助根治性前列腺切除术后国际泌尿病理学会（ISUP）分级升级的临床意义和危险因素。
Clinical significance and risk factors of International Society of Urological Pathology (ISUP) grade upgrading in prostate cancer patients undergoing robot-assisted radical prostatectomy.
机构信息
Division of Innovative Cancer Therapy, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Minato-Ku, Tokyo, Japan.
Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-Ku, Tokyo, Japan.
出版信息
BMC Cancer. 2021 May 4;21(1):501. doi: 10.1186/s12885-021-08248-y.
BACKGROUND
The objective of this study is to investigate the clinical significance and risk factors of upgrading in the International Society of Urological Pathology (ISUP) Grade Group System in men undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer.
METHODS
A total of 583 patients diagnosed with prostate cancer by systematic biopsy were treated with RARP without neoadjuvant therapy from November 2011 to December 2018. Clinicopathological data were obtained from our clinical records. ISUP grade upgrading (IGU) was defined as 'ISUP grade in prostatectomy specimen determined to be higher than that in the biopsy specimen'. Clinicopathological factors, including age, PSA, prostate volume at biopsy (PV), PSA density, clinical stage, body mass index (BMI), interval from biopsy to prostatectomy, maximum percentage of cancer involvement per core (%CI), total number of biopsy cores, percentage of cancer positive biopsy cores (%PC), and sampling density were analyzed to detect potential risk factors of IGU. Biochemical recurrence (BCR) rates were calculated to analyze the effect of IGU on cancer prognosis.
RESULTS
In univariate analysis, BMI was a positive predictor of IGU, while %CI, %PC, and sampling density were negative predictors of IGU. BMI and %PC were statistically significant predictors of IGU in multivariate analysis. For cases diagnosed as ISUP grade group 2 or higher at biopsy, there was a significant difference in BCR rates between cases with and without IGU.
CONCLUSIONS
The results from our cohort showed that elements of both high-grade cancer risk (such as BMI) and sampling efficiency (such as %PC) contribute to IGU. Excluding cases diagnosed as ISUP grade group 1 at biopsy, BCR-free rates were significantly worse in cases with IGU, highlighting the need for more accurate pathological diagnosis at biopsy.
背景
本研究旨在探讨在接受机器人辅助前列腺根治性切除术（RARP）治疗前列腺癌的患者中，国际泌尿病理学会（ISUP）分级系统中升级的临床意义和危险因素。
方法
共 583 例经系统活检诊断为前列腺癌的患者于 2011 年 11 月至 2018 年 12 月期间接受了无新辅助治疗的 RARP 治疗。从临床记录中获取临床病理数据。ISUP 分级升级（IGU）定义为“前列腺切除标本中确定的 ISUP 分级高于活检标本中的分级”。分析年龄、PSA、前列腺活检时体积（PV）、PSA 密度、临床分期、体重指数（BMI）、活检至前列腺切除术的时间间隔、每芯最大癌症累及百分比（%CI）、活检芯总数、癌症阳性活检芯百分比（%PC）和采样密度等临床病理因素，以检测 IGU 的潜在危险因素。计算生化复发（BCR）率以分析 IGU 对癌症预后的影响。
结果
在单因素分析中，BMI 是 IGU 的正预测因子，而%CI、%PC 和采样密度是 IGU 的负预测因子。在多因素分析中，BMI 和%PC 是 IGU 的统计学显著预测因子。对于在活检时诊断为 ISUP 分级组 2 或更高的病例，IGU 病例与无 IGU 病例之间的 BCR 率存在显著差异。
结论
本队列研究结果表明，高分级癌症风险因素（如 BMI）和采样效率因素（如%PC）都与 IGU 有关。排除在活检时诊断为 ISUP 分级组 1 的病例，IGU 病例的无 BCR 率显著较差，突出了在活检时进行更准确的病理诊断的必要性。
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