Falagario Ugo Giovanni, Sanguedolce Francesca, Cormio Angelo, Ninivaggi Antonella, Finati Marco, Guzzi Francesco, Busetto Gian Maria, Bettocchi Carlo, Castellani Daniele, Carrieri Giuseppe, Cormio Luigi
Department of Urology and Renal Transplantation, Policlinico Foggia, University of Foggia, 71122 Foggia, Italy.
Department of Molecular Medicine and Surgery (Solna), Karolinska Institutet, 171 76 Stockholm, Sweden.
Diagnostics (Basel). 2025 Jan 13;15(2):166. doi: 10.3390/diagnostics15020166.
There is emerging evidence of an inverse association between prostatic inflammation (PI) and prostate cancer (PCa) diagnosis and outcome. The Irani score, a validated system that scores PI according to the grade of stromal infiltration (Irani G) and the aggressiveness of glandular infiltration (Irani A), has indeed been found to be inversely associated with PCa diagnosis and outcome, but the presence of two categories (G and A) makes the performance of this score suboptimal. This study aimed to determine whether a novel prostatic inflammation score (PIS) that combines Irani G and A scores better defined the risk of being diagnosed with PCa at prostate biopsy (PBx). Between January 2013 and December 2023, the Irani scores were routinely assessed on hematoxylin and eosin-stained PBx cores. The novel PIS was obtained by combining Irani G and A scores by their kernel distribution. PIS 1 included patients who scored G 0-1/A 0-1, PIS 2 those who scored G 2-3/A 0-1, and PIS 3 included those who scored G 0-3/A 2-3. Logistic regression analysis was used to test the association between the novel PIS and the risk of being diagnosed with PCa and clinically significant (cs) PCa at PBx. Among the 4620 eligible patients, PCa and csPCa detection rate was 47% and 25%, respectively. Overall, 3088 (66.8%) had low Irani G and 4041 (87.5%) had low Irani A scores. Using PIS, 2971 (64%) were classified as PIS 1, 1070 (23%) as PIS 2, and 579 (13%) as PIS 3. Notably, almost one-quarter of patients had heterogeneous Irani features. Multivariable analysis pointed out a significant association between PIS and the risk of being diagnosed with PCa and csPCa; the higher the PIS, the lower the likelihood of such diagnoses. Limitations included the absence of external validation. The novel PIS, easily obtained during routine pathology examination, was significantly associated with the risk of being diagnosed with PCa and csPCa at PBx. While PI seems to be overall protective over PCa, the different types (stromal vs. glandular) of inflammation depicted by PIS seem to express a different risk.
越来越多的证据表明，前列腺炎症（PI）与前列腺癌（PCa）的诊断及预后呈负相关。伊拉尼评分是一种经过验证的系统，根据基质浸润程度（伊拉尼G）和腺性浸润的侵袭性（伊拉尼A）对PI进行评分，确实已发现其与PCa的诊断及预后呈负相关，但由于存在两个类别（G和A），该评分的性能并不理想。本研究旨在确定一种结合伊拉尼G和A评分的新型前列腺炎症评分（PIS）是否能更好地界定前列腺穿刺活检（PBx）时被诊断为PCa的风险。在2013年1月至2023年12月期间，对苏木精和伊红染色的PBx组织芯常规评估伊拉尼评分。新型PIS通过将伊拉尼G和A评分按其核分布进行合并获得。PIS 1包括伊拉尼G评分为0 - 1/A评分为0 - 1的患者，PIS 2包括伊拉尼G评分为2 - 3/A评分为0 - 1的患者，PIS 3包括伊拉尼G评分为0 - 3/A评分为2 - 3的患者。采用逻辑回归分析来检验新型PIS与PBx时被诊断为PCa及临床显著（cs）PCa风险之间的关联。在4620名符合条件的患者中，PCa和csPCa的检出率分别为47%和25%。总体而言，3088名（66.8%）患者伊拉尼G评分低，4041名（87.5%）患者伊拉尼A评分低。使用PIS，2971名（64%）患者被归类为PIS 1，1070名（23%）为PIS 2，579名（13%）为PIS 3。值得注意的是，近四分之一的患者具有异质性伊拉尼特征。多变量分析指出PIS与被诊断为PCa及csPCa的风险之间存在显著关联；PIS越高，此类诊断的可能性越低。局限性包括缺乏外部验证。新型PIS在常规病理检查过程中易于获得，与PBx时被诊断为PCa及csPCa的风险显著相关。虽然PI总体上似乎对PCa有保护作用，但PIS所描述的不同类型（基质性与腺性）炎症似乎表达了不同的风险。
