Sciorio Carmine, Giannella Riccardo, Romano Lorenzo, Mirto Benito Fabio, Di Girolamo Antonio, Ruffo Antonio, Romeo Giuseppe, Esposito Fabio, Crocetto Felice, Napolitano Luigi, Balsamo Raffaele, Trama Francesco, Bottone Francesco, Quattrone Carmelo, Imperatore Vittorio, Spirito Lorenzo
UOC Urologia, Ospedale Manzoni, 23900 Lecco, Italy.
UOC Urologia, AORN "A. Cardarelli", 80131 Napoli, Italy.
Diagnostics (Basel). 2025 May 14;15(10):1238. doi: 10.3390/diagnostics15101238.
In prostate cancer (PCa) patients, discrepancies between biopsy-assigned Gleason Scores and those determined from surgical specimens are frequently reported. This phenomenon, known as Gleason score upgrade (GSU), can have significant clinical implications. This work aims to understand the factors contributing to GSU for refining prostate cancer management strategies. Data from 779 patients diagnosed with histologically confirmed PCa who underwent robot-assisted radical prostatectomy at a single tertiary care institution between January 2005 and December 2020 were examined. In the univariable setting, 5-alpha reductase inhibitor (5-ARI) use was associated with a higher percentage of upgrading (42.3% vs. 30.4% among non-users; = 0.03942). A more advanced pathological T stage ( = 0.01114) and lymph node positivity ( < 0.00001) correlated significantly with GSU. In the logistic regression model, advanced pathological stage increased the odds more than twofold (OR = 2.807, = 0.00135). 5-ARI use was associated with notably higher odds of upgrading (OR = 3.809, = 0.00004). Younger age slightly increased the likelihood of GSU (OR = 0.951 per year increase in age, = 0.01101). Younger age, advanced pathological stage, and the use of 5-alpha reductase inhibitors were identified as significant predictors of GSU.
在前列腺癌（PCa）患者中，活检指定的 Gleason 评分与手术标本确定的评分之间存在差异的情况屡有报道。这种现象被称为 Gleason 评分升级（GSU），可能具有重大的临床意义。这项研究旨在了解导致 GSU 的因素，以优化前列腺癌管理策略。我们研究了 2005 年 1 月至 2020 年 12 月期间在一家三级医疗中心接受机器人辅助根治性前列腺切除术、组织学确诊为 PCa 的 779 例患者的数据。在单变量分析中，使用 5α还原酶抑制剂（5-ARI）与更高的升级百分比相关（非使用者中为 30.4%，使用者中为 42.3%；P = 0.03942）。更高级别的病理 T 分期（P = 0.01114）和淋巴结阳性（P < 0.00001）与 GSU 显著相关。在逻辑回归模型中，晚期病理分期使升级几率增加两倍多（OR = 2.807，P = 0.00135）。使用 5-ARI 与显著更高的升级几率相关（OR = 3.809，P = 0.00004）。年龄较小略微增加了 GSU 的可能性（年龄每增加一岁，OR = 0.951，P = 0.01101）。年龄较小、晚期病理分期和使用 5α还原酶抑制剂被确定为 GSU 的重要预测因素。
