前列腺癌 Gleason 评分 7 级升级是否总是预示着更差的预后？

Does the Gleason Score 7 Upgrading Always Predict Worse Prognosis?

机构信息

Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

出版信息

Clin Genitourin Cancer. 2023 Dec;21(6):e412-e421. doi: 10.1016/j.clgc.2023.05.002. Epub 2023 May 7.

DOI:10.1016/j.clgc.2023.05.002

PMID:37248147

Abstract

OBJECTIVE

To determine the clinical significance of Gleason score(GS) 7 upgraded on radical prostatectomy(RP) and its impact on the prognosis of patients.

PATIENTS AND METHODS

We used the Surveillance, Epidemiology, and End Results (SEER) database to study 8832 men diagnosed with M0 GS 3+4/4+3 prostate cancer (PCa) from 2010 to 2015 treated by RP. Logistic regression was used to analyze the effect of clinicopathological characteristics on the Gleason sore upgraded. Cox hazards regression analysis was performed to find significant factors of overall survival (OS).

RESULTS

A total of 6237 (70.6%) biopsy GS 3+4 patients and 2595(29.4%) biopsy GS 4+3 patients were included in the study. Univariate and multivariate logistic regression analysis found that prostate-specific antigen (PSA)>20ng/ml, T stage 3-4, lymph node metastasis are independent risk factors in predicting the incidence of GS upgraded after RP (all P<0.05). Through multivariate analysis, we found that black race, GS upgraded, chemotherapy played significant roles in predicting poor OS (all P<0.05). It was surprising to find that the biopsy GS upgraded in patients with PSA 0-4ng/ml and 4.1-10ng/ml had a significant association with poor OS (all P<0.05). Multivariate analysis showed that only in patients with PSA 4-10ng/ml, biopsy GS upgrade had a statistically important relationship with poor OS (P=0.046).

CONCLUSIONS

Not all patients with GS 7 upgraded had a worse prognosis than those without GS upgraded. Only in patients with PSA 4.1-10ng/ml, biopsy GS 7 upgraded was an independent risk factor affecting OS.

摘要

目的

确定前列腺根治性切除术（RP）后 Gleason 评分（GS）升级 7 的临床意义及其对患者预后的影响。

患者与方法

我们使用监测、流行病学和最终结果（SEER）数据库研究了 2010 年至 2015 年间接受 RP 治疗的 8832 名诊断为 M0 GS 3+4/4+3 前列腺癌（PCa）的男性患者。使用逻辑回归分析临床病理特征对 Gleason 评分升级的影响。采用 Cox 风险回归分析寻找总生存（OS）的显著因素。

结果

共纳入 6237 例（70.6%）活检 GS 3+4 患者和 2595 例（29.4%）活检 GS 4+3 患者。单因素和多因素逻辑回归分析发现，前列腺特异性抗原（PSA）>20ng/ml、T 分期 3-4 期、淋巴结转移是预测 RP 后 GS 升级发生率的独立危险因素（均 P<0.05）。通过多因素分析，我们发现黑种人、GS 升级、化疗在预测不良 OS 中起重要作用（均 P<0.05）。令人惊讶的是，在 PSA 0-4ng/ml 和 4.1-10ng/ml 的患者中，活检 GS 升级与不良 OS 显著相关（均 P<0.05）。多因素分析显示，只有在 PSA 4-10ng/ml 的患者中，活检 GS 升级与不良 OS 有统计学上的显著关系（P=0.046）。