术前血清前列腺特异性抗原和Gleason分级作为临床器官局限性前列腺癌病理分期的预测指标：对初始治疗选择的意义

Preoperative serum prostate-specific antigen and Gleason grade as predictors of pathologic stage in clinically organ confined prostate cancer: implications for the choice of primary treatment.

作者信息

Ennis R D, Flynn S D, Fischer D B, Peschel R E

机构信息

Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06510.

出版信息

Int J Radiat Oncol Biol Phys. 1994 Sep 30;30(2):317-22. doi: 10.1016/0360-3016(94)90010-8.

DOI:10.1016/0360-3016(94)90010-8

PMID:7523342

Abstract

PURPOSE

Despite careful preoperative staging, approximately 50% of patients who undergo radical prostatectomy for clinical stage A2 (T1b-c) and B (T2) prostate cancer are found to have pathologic stage C (T3-4) or D (N1) disease. This study investigates whether preoperative serum prostate specific antigen (PSA) and Gleason grade predict pathologic stage among patients with clinically organ confined prostate cancer.

METHODS

The records of all 63 patients who underwent attempted pelvic lymphadenectomy and radical prostatectomy for adenocarcinoma of the prostate at our institution in 1990-91 were retrospectively reviewed.

RESULTS

Patients with a preoperative serum PSA of 12.5 ng/mL or greater had an 81% incidence of pathologic upstaging to stage C (T3-4) or D (N1) compared with 38% for patients with a PSA less than 12.5 (p = 0.0015). The incidence of various pathologic findings for prostate specific antigen > or = 12.5 vs. prostate specific antigen < 12.5 was as follows: seminal vesicle involvement 29% vs. 5% (p = 0.0186), lymph node metastases 24% vs. 0% (p = 0.0029), capsular penetration 71% vs. 38% (p = 0.0424), and positive margins 47% vs. 36% (p = 0.56). None (0/3) of the patients with Gleason grade 4 or less were pathologically upstaged compared with 49% (24/49) of patients with grade 5-7 tumors (p = 0.15) and 82% (9/11) of patients with grade 8 or higher cancers (p = 0.0474, grade 5-7 vs. 8-10). Within the group of patients with Gleason grade 5-7, a prostate specific antigen of 12.5 ng/mL or greater predicted an 79% rate of upstaging compared with 37% for patients with prostate specific antigen less than 12.5 (p = 0.0098).

CONCLUSION

Patients with clinical Stage A2 (T1b-c) or B (T2) prostate cancer who have Gleason grade 8-10 tumors and those patients with Gleason grade 5-7 tumors with a preoperative serum prostate specific antigen of 12.5 ng/mL or higher have a high incidence of pathologic upstaging. These patients should be preferentially treated with external beam radiation in most cases.

摘要

目的

尽管进行了仔细的术前分期，但接受根治性前列腺切除术的临床A2期（T1b - c）和B期（T2）前列腺癌患者中，约50%被发现患有病理分期为C期（T3 - 4）或D期（N1）疾病。本研究调查术前血清前列腺特异性抗原（PSA）和 Gleason分级是否能预测临床局限于器官内的前列腺癌患者的病理分期。

方法

回顾性分析了1990 - 1991年在我院接受盆腔淋巴结清扫术和前列腺癌根治术的63例患者的病历。

结果

术前血清PSA≥12.5 ng/mL的患者病理分期上调至C期（T3 - 4）或D期（N1）的发生率为81%，而PSA＜12.5的患者为38%（p = 0.0015）。PSA≥12.5与PSA＜12.5的各种病理结果发生率如下：精囊受累29%对5%（p = 0.0186），淋巴结转移24%对0%（p = 0.0029），包膜侵犯71%对38%（p = 0.0424），切缘阳性47%对36%（p = 0.56）。Gleason分级4级及以下的患者无一例病理分期上调，而Gleason分级5 - 7级肿瘤患者中有49%（24/49）分期上调，Gleason分级8级及以上癌症患者中有82%（9/11）分期上调（p = 0.0474，5 - 7级对8 - 10级）。在Gleason分级5 - 7级的患者组中，PSA≥12.5 ng/mL的患者分期上调率为79%，而PSA＜12.5的患者为37%（p = 0.0098）。