Kramer S A, Spahr J, Brendler C B, Glenn J F, Paulson D F
J Urol. 1980 Aug;124(2):223-5. doi: 10.1016/s0022-5347(17)55381-1.
The inaccuracy of clinical staging as a predictor of the biologic potential of prostatic cancer has prompted evaluation of additional methods of assessment. We reviewed 228 patients with prostatic adenocarcinoma who presented during a 4-year period. Of the 228 patients 144 with no detectable bony disease underwent staging pelvic lymphadenectomy with or without preliminary bilateral pedal lymphangiography. Histopathologic specimens of the primary diagnostic prostatic biopsy were classified with Gleason's grading system of tumor differentiation. Of the patients with Gleason's sum of 8, 9 or 10, 93 per cent had regional nodal metastases, regardless of preliminary clinical stage. Furthermore, no patient with Gleason's sum of 2, 3 or 4 had nodal metastatic disease. The incidences of falsely positive and falsely negative lymphangiograms were 29 and 35 per cent, respectively, reflecting the unreliability of pedal lymphangiography to predict nodal involvement accurately in patients with prostatic cancer. The Gleason system of histopathologic grading was reliable and reproducible, and afforded an accurate prediction of the surgical stage of disease.
临床分期作为前列腺癌生物学潜能预测指标的不准确性促使人们对其他评估方法进行评价。我们回顾了4年间就诊的228例前列腺腺癌患者。在这228例患者中，144例无可检测到的骨转移疾病的患者接受了分期盆腔淋巴结切除术，部分患者还进行了双侧足背淋巴管造影。原发性诊断性前列腺活检的组织病理学标本根据Gleason肿瘤分化分级系统进行分类。在Gleason评分总和为8、9或10的患者中，93%有区域淋巴结转移，与初始临床分期无关。此外，Gleason评分总和为2、3或4的患者无淋巴结转移疾病。淋巴管造影假阳性和假阴性的发生率分别为29%和35%，这反映了足背淋巴管造影在准确预测前列腺癌患者淋巴结受累方面的不可靠性。组织病理学分级的Gleason系统可靠且可重复，能够准确预测疾病的手术分期。
