Urology Oncology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Urologia. 2023 May;90(2):236-243. doi: 10.1177/03915603221118457. Epub 2022 Aug 16.
The Gleason score is an essential factor for making decisions about prostate cancer management and its prognosis. Thus, we conducted this research to discover the histologic-grading accuracy of needle biopsy specimens, and to identify preoperative clinical and pathological factors that predict upgrading and downgrading from biopsy to radical prostatectomy specimen.
This study was performed on 570 patients who were referred to the medical centers affiliated with Shiraz University of Medical Sciences and underwent radical prostatectomy from 2013 to 2017. Concordance was evaluated between the Gleason score of needle biopsy and radical prostatectomy specimens. Predictors of upgrades and downgrades were assessed in univariate and multivariate logistic regression analyses.
Scores were the same in 50% of cases, downgraded in 26%, and upgraded in 24%. The variables predicting a Gleason score upgrade were higher Prostate specific antigen level, larger tumors, and older age. Lower tumor volume, lower Prostate specific antigen, and low maximum percentage of cancer in cores were predictors of downgrading from Gleason score>6 to ⩽6. Also, Body mass index>30, smaller tumor size, and negative lymph nodes were predictors of downgrading from Gleason score>7 to 7.
The correlation between biopsy and Radical prostatectomy Gleason scores was only 50%. After dividing them into the new grading groups, this coordination increased by only 5.6%. Physicians need to consider possible limitations of the Gleason score of biopsy and factors that can be predictive of upgrading to high-risk prostate cancer before making treatment decisions.
格里森评分是决定前列腺癌管理和预后的重要因素。因此，我们进行了这项研究，以发现针吸活检标本的组织学分级准确性，并确定术前临床和病理因素，这些因素可预测从活检到根治性前列腺切除术标本的升级和降级。
这项研究共纳入了 570 名患者，他们于 2013 年至 2017 年期间被转诊至 Shiraz 大学医学科学附属的医疗中心，并接受了根治性前列腺切除术。评估了针吸活检和根治性前列腺切除术标本之间的格里森评分一致性。在单变量和多变量逻辑回归分析中评估了升级和降级的预测因素。
50%的病例评分相同，26%的病例评分降低，24%的病例评分升高。预测格里森评分升高的变量是前列腺特异性抗原水平较高、肿瘤较大和年龄较大。肿瘤体积较小、前列腺特异性抗原较低、核心中癌症的最大百分比较低是预测从格里森评分>6 降至 ⩽6 的降级因素。此外，体重指数>30、肿瘤较小和淋巴结阴性是预测从格里森评分>7 降至 7 的降级因素。
活检和根治性前列腺切除术格里森评分之间的相关性仅为 50%。将其分为新的分级组后，这种协调性仅增加了 5.6%。在做出治疗决策之前，医生需要考虑活检格里森评分的可能局限性以及可能预测高危前列腺癌升级的因素。
