Epstein J I, Carmichael M J, Pizov G, Walsh P C
Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland 21205.
J Urol. 1993 Jul;150(1):135-41. doi: 10.1016/s0022-5347(17)35415-0.
We studied 196 radical prostatectomy cases performed for clinical stage B prostate cancer with capsular penetration; in all cases seminal vesicles and lymph nodes were free of tumor. The mean followup in patients who showed no evidence of progression was 5 years. Focal capsular penetration was seen in 93 cases. There was no difference in progression in this group, irrespective of whether margins were negative or positive. High grade tumors (Gleason score 7 or more) had a significantly higher risk of progression compared to lower grade tumors (p = 0.0002). Established capsular penetration was seen in 103 tumors. Cancers with established capsular penetration had a higher risk of progression than those with focal capsular penetration. Established capsular penetration tumors were stratified into 3 groups with increasing risks of progression: 1) margins were negative and grade was low, 2) margins were positive or grade was high yet both adverse features were not present or 3) margins were positive and grade was high. The differences in progression among these 3 groups were statistically significant. Because of the negligible influence of positive margins in patients with focal capsular penetration the status of capsular margins should not influence the decision on whether to administer immediate postoperative adjuvant therapy. To evaluate the efficacy of adjuvant therapy following radical prostatectomy, tumors with capsular penetration should be stratified into groups having similar risks of progression according to the extent of capsular penetration, surgical margins of resection and grade.
我们研究了196例因临床分期为B期且有包膜侵犯的前列腺癌而行根治性前列腺切除术的病例；所有病例的精囊和淋巴结均无肿瘤。在无疾病进展证据的患者中，平均随访时间为5年。93例可见局灶性包膜侵犯。该组患者的疾病进展情况无差异，无论手术切缘是阴性还是阳性。与低级别肿瘤相比，高级别肿瘤（Gleason评分7分及以上）的疾病进展风险显著更高（p = 0.0002）。103例肿瘤可见明确的包膜侵犯。有明确包膜侵犯的癌症比有局灶性包膜侵犯的癌症有更高的疾病进展风险。有明确包膜侵犯的肿瘤被分为3组，疾病进展风险逐渐增加：1）手术切缘阴性且级别低，2）手术切缘阳性或级别高，但不存在这两个不良特征，或3）手术切缘阳性且级别高。这3组之间的疾病进展差异具有统计学意义。由于局灶性包膜侵犯患者手术切缘阳性的影响可忽略不计，包膜切缘状态不应影响是否给予术后即刻辅助治疗的决策。为评估根治性前列腺切除术后辅助治疗的疗效，对于有包膜侵犯的肿瘤，应根据包膜侵犯程度、手术切除切缘及级别，将其分为疾病进展风险相似的组。
