Miller G J, Cygan J M
Department of Pathology, University of Colorado Health Sciences Center, Denver.
J Urol. 1994 Nov;152(5 Pt 2):1709-13. doi: 10.1016/s0022-5347(17)32368-6.
A series of 151 radical prostatectomy specimens were subjected to whole-mount analysis. Features examined included histological grade, tumor volume, pathological stage and multifocality. Only 43.7% of the prostates contained a single carcinoma, 31.1% had 2 separate foci and the remaining 25.2% contained 3 to 6 tumors. Multifocality was greatest among tumors with the lowest mean volumes. Tumors with volumes of less than 3 cc were found in all grades (Gleason sums of 2 through 10). The highest volume tumors were those of intermediate grade (Gleason sums 4 through 8). Among tumors with volumes of less than 1 cc 70% that were confined within the prostatic capsule had Gleason sums of 4 or less. However, tumors with volumes of less than 3 cc that had invaded through the prostatic capsule were nearly equally divided between Gleason sums of 2, 3 or 4 and those of 5, 6 or 7. While studies examining the largest tumor per prostate have suggested that histological grade and volume are closely related, our results indicate that this is not necessarily the case. Furthermore, it is clear that tumors need not acquire either large volume or high grade before they can become locally invasive. It is likely, therefore, that the prediction of prognosis for patients with prostatic cancer is greatly influenced by tumor multifocality.
对151份前列腺癌根治术标本进行了整体分析。所检查的特征包括组织学分级、肿瘤体积、病理分期和多灶性。只有43.7%的前列腺含有单个癌灶，31.1%有2个独立病灶，其余25.2%含有3至6个肿瘤。多灶性在平均体积最小的肿瘤中最为常见。所有分级（Gleason评分2至10）的肿瘤中均发现体积小于3 cc的肿瘤。体积最大的肿瘤为中等分级（Gleason评分4至8）。在体积小于1 cc且局限于前列腺包膜内的肿瘤中，70%的Gleason评分为4或更低。然而，体积小于3 cc且已侵犯前列腺包膜的肿瘤在Gleason评分2、3或4与5、6或7之间几乎平分。虽然对每个前列腺中最大肿瘤的研究表明组织学分级和体积密切相关，但我们的结果表明情况并非一定如此。此外，很明显肿瘤在发生局部浸润之前不一定需要达到大体积或高分级。因此，前列腺癌患者预后的预测很可能受到肿瘤多灶性的极大影响。
