Björklund Johan, Cheung Douglas C, Martin Lisa J, Komisarenko Maria, Lajkosz Katharine, Hamilton Robert J, Zlotta Alexandre R, Finelli Antonio
Division of Urologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Canada.
Department of Molecular Medicine and Surgery, Karolinska Institutet and Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
Scand J Urol. 2023 Feb-Dec;57(1-6):29-35. doi: 10.1080/21681805.2023.2165709. Epub 2023 Jan 23.
Guidelines support considering selected men with ISUP grade group (GG) 2 prostate cancer for active surveillance (AS). We assessed the association of clinical variables with unfavorable pathology at radical prostatectomy in low-volume GG 2 prostate cancer on biopsy in a retrospective cohort.
This was a retrospective analysis of 378 men with low-volume (≤ 2 cores) GG 2 localized prostate cancer who underwent prostatectomy at a single tertiary cancer center. Multivariable logistic regression of unfavorable pathology, upgrading to ≥ T3, or GG ≥ 3 was performed in relation to clinical factors, common variables used in AS in GG 1 and percentage Gleason 4 at biopsy. We compared the performance of potential variables with commonly used combined AS restrictions in GG 1 prostate cancer.
In total, 128/378 (34%) men had unfavorable pathology at radical prostatectomy. On multivariable analysis, > 5% Gleason pattern 4 was independently associated with an increased risk of GG ≥ 3. A maximum percentage core involvement > 50% was independently associated with an increased risk of pT-stage ≥ 3 and unfavorable pathology. Restriction to patients with ≤ 5% Gleason 4 decreased the upgrading of both unfavorable pathology (OR = 0.62, = 0.041) and GG ≥ 3 (OR = 0.17, = 0.0007) compared to the full cohort, while restriction to those with ≤ 50% of max core involvement did not.
In low-volume GG 2, the percentage of Gleason 4 of ≤ 5% was the strongest predictor in reducing upgrading at final pathology. This easily available pathological descriptor could be used to guide urologists and patients when considering AS in this setting.
指南支持将部分国际泌尿病理学会（ISUP）分级组（GG）2前列腺癌男性患者纳入主动监测（AS）。我们在一项回顾性队列研究中评估了低体积GG 2前列腺癌活检时临床变量与根治性前列腺切除术后不良病理结果之间的关联。
这是一项对378例低体积（≤2个穿刺核心）GG 2局限性前列腺癌男性患者的回顾性分析，这些患者在单一的三级癌症中心接受了前列腺切除术。针对临床因素、GG 1中AS常用的共同变量以及活检时Gleason 4级的百分比，对不良病理结果、升级至≥T3或GG≥3进行多变量逻辑回归分析。我们比较了潜在变量与GG 1前列腺癌中常用的联合AS限制标准的性能。
总共128/378（34%）例男性患者在根治性前列腺切除术后出现不良病理结果。多变量分析显示，Gleason 4级模式>5%与GG≥3风险增加独立相关。最大穿刺核心受累百分比>50%与pT分期≥3及不良病理结果风险增加独立相关。与整个队列相比，将标准限制为Gleason 4级≤5%的患者可降低不良病理结果（OR = 0.62，P = 0.041）和GG≥3（OR = 0.17，P = 0.0007）的升级率，而将标准限制为最大穿刺核心受累≤50%的患者则不能。
在低体积GG 2前列腺癌中，Gleason 4级≤5%是降低最终病理升级的最强预测因素。在这种情况下，这个易于获得的病理描述符可用于指导泌尿科医生和患者考虑AS。
