Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Asian J Androl. 2022 Sep-Oct;24(5):487-493. doi: 10.4103/aja2021108.
We performed this study to investigate pathological upgrading from biopsy to prostatectomy and clinicopathological factors associated with grade group (GG) upgrading in patients with International Society of Urological Pathology (ISUP) GG 1 and 2 prostate cancer (PCa) in a Chinese cohort. We included patients diagnosed with PCa with ISUP GG 1 and 2 at biopsy, who underwent RP at our institution. Pre- and postoperative clinical variables were examined. Univariate and multivariate logistic regression analyses were conducted to identify independent factors associated with GG upgrading. Patients in GG upgraded group had higher total prostate-specific antigen (tPSA; median: 14.43 ng ml vs 10.52 ng ml, P = 0.001) and PSA density (PSAD; median: 0.45 ng ml vs 0.27 ng ml, P < 0.001) than those in GG nonupgraded group. Patients in upgraded group had a higher ratio for Prostate Imaging-Reporting and Data System (PI-RADS) score >3 (86.4% vs 67.9%, P < 0.001). Those with GG 1 in biopsy were more likely to experience GG upgrading after RP than those with GG 2 (71 vs 54, P = 0.016). Independent preoperative factors predicting GG upgrading were PI-RADS score >3 (odds ratio [OR]: 2.471, 95% confidence interval [CI]: 1.132-5.393; P = 0.023), higher PSAD (P = 0.001), and GG in biopsy (OR: 0.241, 95% CI: 0.123-0.471; P < 0.001). The histopathological analyses of RP specimens revealed that perineural invasion (PNI; OR: 1.839, 95% CI: 1.027-3.490; P = 0.041) was identified as an independent factor associated with GG upgrading. Our results revealed that GG in the biopsy, PSAD, PI-RADS score >3, and PNI were independent factors of GG upgrading. These factors should be considered for patients with ISUP grade ≤2 PCa.
我们进行了这项研究，旨在探讨中国人群中国际泌尿病理学会（ISUP）分级 1 和 2 前列腺癌（PCa）患者从活检到前列腺切除术的病理升级以及与分级组（GG）升级相关的临床病理因素。我们纳入了在我院接受 RP 治疗的经活检诊断为 ISUP GG 1 和 2 PCa 的患者。检查了术前和术后的临床变量。进行了单变量和多变量逻辑回归分析，以确定与 GG 升级相关的独立因素。GG 升级组的患者总前列腺特异性抗原（tPSA；中位数：14.43ng/ml 比 10.52ng/ml，P=0.001）和 PSA 密度（PSAD；中位数：0.45ng/ml 比 0.27ng/ml，P<0.001）均高于 GG 非升级组。升级组患者前列腺影像报告和数据系统（PI-RADS）评分>3 的比例更高（86.4%比 67.9%，P<0.001）。活检时 GG 1 的患者比 GG 2 的患者更有可能在 RP 后经历 GG 升级（71 比 54，P=0.016）。预测 GG 升级的独立术前因素包括 PI-RADS 评分>3（优势比[OR]：2.471，95%置信区间[CI]：1.132-5.393；P=0.023）、较高的 PSAD（P=0.001）和活检时的 GG（OR：0.241，95%CI：0.123-0.471；P<0.001）。RP 标本的组织病理学分析显示，神经周围侵犯（PNI；OR：1.839，95%CI：1.027-3.490；P=0.041）是与 GG 升级相关的独立因素。我们的结果表明，活检中的 GG、PSAD、PI-RADS 评分>3 和 PNI 是 GG 升级的独立因素。对于 ISUP 分级≤2 PCa 的患者，应考虑这些因素。
