Greene D R, Wheeler T M
Mater Hospital, Dublin, Ireland.
Cancer Invest. 1994;12(4):425-37. doi: 10.3109/07357909409038236.
The course of stage A prostate cancer is difficult to predict because some of the tumors sampled at TURP are histologically "latent" (resembling cancer discovered incidentally at autopsy) and others have the ability to progress clinically. TURP selectively samples cancer in the transition zone, but, as we noted, the pattern of cancer in the TURP was a limited predictor of residual cancer. Furthermore, peripheral zone cancer appeared histologically to have a higher grade, volume for volume, than transition zone cancer and, in our study, was more frequently associated with extraprostatic spread of cancer. Peripheral zone cancer, while sampled in a minority of TURPs (less than 20%), is associated with histological predictors of poor prognosis. In the ploidy study, peripheral zone cancer was sampled in 5 patients, 4 of whom had nondiploid residual cancer in the radical prostatectomy specimen. Three of these 5 had extracapsular extension and 2 had seminal vesicle invasion. The frequent pattern in stage A1 is, therefore, a low-volume, diploid, transition zone cancer in the TURP specimen. In most cases this was associated with one or more small diploid transition zone or peripheral zone cancers in the radical prostatectomy specimen. However, in some cases, a residual nondiploid cancer was present that could eventually cause progression. The pattern of cancer in stage A2 differs from that in stage A1 in that most large transition zone cancers are selected into this stage and some of these are nondiploid. Stage A2, therefore, includes the minority of transition zone cancers that are nondiploid as well as a considerable number of peripheral zone cancers that are nondiploid. In both stages A1 and A2 nondiploid peripheral zone cancers outnumbered nondiploid transition zone cancers. The relationship of tumor volume with ploidy is clearly different for peripheral zone and transition zone cancers. Eight peripheral zone cancers less than 2.0 cc were nondiploid but only 1 transition zone cancer less than 2.0 cc was nondiploid. Furthermore, all peripheral zone cancers greater than 2.0 cc were nondiploid whereas only 50% of transition zone cancers greater than 2.0 cc were nondiploid. There was a significant difference between tumor volume of diploid and nondiploid cancers. Presumably, nondiploid cell lines have a growth advantage and are more poorly differentiated than diploid cancers. Whether DNA ploidy changes occur as a consequence of tumor growth and tumor cell heterogeneity is unclear because of range in volume of tumors studied.(ABSTRACT TRUNCATED AT 400 WORDS)
A期前列腺癌的病程难以预测，因为经尿道前列腺切除术（TURP）所取样本中的一些肿瘤在组织学上是“潜伏性的”（类似于尸检时偶然发现的癌症），而其他肿瘤则有临床进展的能力。TURP选择性地取移行区的癌组织样本，但如我们所指出的，TURP中的癌症模式对残留癌的预测作用有限。此外，从组织学上看，外周区癌的分级似乎比移行区癌更高，在我们的研究中，外周区癌更常与癌的前列腺外扩散相关。外周区癌虽然在少数TURP样本（不到20%）中被取到，但与预后不良的组织学预测指标相关。在倍体研究中，5例患者的外周区癌被取到样本，其中4例在前列腺根治性切除标本中有非二倍体残留癌。这5例中的3例有包膜外侵犯，2例有精囊侵犯。因此，A1期的常见模式是TURP标本中体积小、二倍体的移行区癌。在大多数情况下，这与前列腺根治性切除标本中的一个或多个小的二倍体移行区或外周区癌相关。然而，在某些情况下，存在残留的非二倍体癌，最终可能导致病情进展。A2期的癌症模式与A1期不同，因为大多数大的移行区癌被归入此期，其中一些是非二倍体的。因此，A2期包括少数非二倍体的移行区癌以及相当数量的非二倍体外周区癌。在A1期和A2期，非二倍体外周区癌的数量都超过非二倍体移行区癌。外周区癌和移行区癌的肿瘤体积与倍体的关系明显不同。8例体积小于2.0 cc的外周区癌是非二倍体的，但体积小于2.0 cc的移行区癌只有1例是非二倍体的。此外所有体积大于2.0 cc的外周区癌都是非二倍体的，而体积大于2.0 cc的移行区癌只有50%是非二倍体的。二倍体癌和非二倍体癌的肿瘤体积存在显著差异。推测非二倍体细胞系具有生长优势，且比二倍体癌的分化程度更低。由于所研究肿瘤的体积范围不同，尚不清楚DNA倍体变化是否是肿瘤生长和肿瘤细胞异质性的结果。（摘要截选至400字）
