Latcu Silviu Constantin, Cumpanas Alin Adrian, Barbos Vlad, Buciu Victor-Bogdan, Raica Marius, Baderca Flavia, Gaje Pusa Nela, Ceausu Raluca Amalia, Dumitru Cristina-Stefania, Novacescu Dorin, Cut Talida Georgiana, Petrica Ligia
Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania.
Department XV, Discipline of Urology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania.
Life (Basel). 2024 Jun 30;14(7):838. doi: 10.3390/life14070838.
The effective staging of prostate cancer is essential for optimizing treatment and predicting outcomes. This study assessed the correlation between detailed preoperative diagnostic scores and postoperative outcomes to evaluate the accuracy of cancer restaging and its impact on treatment decisions and prognosis after prostatectomy. This retrospective study analyzed 133 prostate cancer patients who underwent prostatectomies at "Pius Brinzeu" Clinical Emergency Hospital in Timisoara over five years. Preoperative Gleason scores increased significantly across risk categories, from an average of 6.21 in low-risk patients to 7.57 in high-risk patients. This trend continued postoperatively, with scores rising from 7.04 to 8.33, respectively. The average increase in Gleason scores from preoperative to postoperative assessments was most pronounced in high-risk patients, at 0.76. Significant changes in clinical staging included increases in NCCN risk, where high-risk patients showed a 30% increase, and ISUP grade, with a 26.7% increase in the high-risk category. Notably, nodal status changes were also significant in high-risk patients, showing a 23.3% increase. The incidence of MRI-detected adenopathy was notably higher in the high-risk group (50%). Furthermore, there were significant correlations between the preoperative CAPRA score and postoperative ISUP grade (r = 0.261) and the preoperative PIRADS score and postoperative ISUP grade (r = 0.306). Similar observations were made between the preoperative and postoperative Gleason scores (r = 0.286) and the number of positive fragments (r = 0.227) with the postoperative ISUP grading. Furthermore, the preoperative CAPRA score was significantly correlated (r = 0.261) with the postoperative ISUP grading. Preoperative MRI findings, which included assessments of adenopathy and seminal vesicle invasion, were also significantly correlated (r = 0.218) with the postoperative pathological findings. Additionally, a significant correlation was found between the preoperative PIRADS score and postoperative ISUP grade (r = 0.306). In forecasting the aggressiveness and staging of prostate cancer following surgery, preoperative PSA levels showed an AUC of 0.631; the preoperative Gleason score had an AUC adjusted to 0.582, and the number of positive biopsy fragments indicated an AUC of 0.566. These results highlight the necessity of accurate and comprehensive preoperative assessments to better predict disease progression and refine treatment strategies.
前列腺癌的有效分期对于优化治疗和预测预后至关重要。本研究评估了详细的术前诊断评分与术后结果之间的相关性，以评估癌症再分期的准确性及其对前列腺切除术后治疗决策和预后的影响。这项回顾性研究分析了133例在蒂米什瓦拉的“皮乌斯·布林泽乌”临床急诊医院接受前列腺切除术的前列腺癌患者，为期五年。术前Gleason评分在不同风险类别中显著增加，从低风险患者的平均6.21分升至高风险患者的7.57分。术后这一趋势仍在持续，评分分别从7.04分升至8.33分。从术前到术后评估，Gleason评分的平均增加在高风险患者中最为明显，为0.76分。临床分期的显著变化包括NCCN风险增加，其中高风险患者增加了30%，ISUP分级增加，高风险类别增加了26.7%。值得注意的是，高风险患者的淋巴结状态变化也很显著，增加了23.3%。MRI检测到的腺病发生率在高风险组中明显更高（50%）。此外，术前CAPRA评分与术后ISUP分级之间存在显著相关性（r = 0.261），术前PIRADS评分与术后ISUP分级之间也存在显著相关性（r = 0.306）。术前和术后Gleason评分（r = 0.286）以及阳性切片数量（r = 0.227）与术后ISUP分级之间也有类似的观察结果。此外，术前CAPRA评分与术后ISUP分级显著相关（r = 0.261）。术前MRI结果，包括对腺病和精囊侵犯的评估，也与术后病理结果显著相关（r = 0.218）。此外，术前PIRADS评分与术后ISUP分级之间存在显著相关性（r = 0.306）。在预测前列腺癌术后的侵袭性和分期方面，术前PSA水平的AUC为0.631；术前Gleason评分的校正AUC为0.582，阳性活检切片数量的AUC为0.566。这些结果凸显了准确和全面的术前评估对于更好地预测疾病进展和优化治疗策略的必要性。
