Epstein J I, Carmichael M, Walsh P C
Department of Pathology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institution, Baltimore, Maryland.
J Urol. 1993 May;149(5):1040-5. doi: 10.1016/s0022-5347(17)36291-2.
An issue relating to uniformity in pathological staging of prostate cancer that has received relatively minimal attention is that of seminal vesicle invasion. Several studies define tumor in the per-seminal vesicle soft tissue as seminal vesicle invasion, while others equate seminal vesicle invasion with tumor invading the muscular wall of the seminal vesicle. There are also controversies regarding the prognostic significance of seminal vesicle invasion compared to capsular penetration, and whether seminal vesicle invasion is a predictor of poor prognosis independent of tumor volume and grade. We evaluated 115 cases of established capsular penetration, 16 of peri-seminal vesicle invasion and 45 of seminal vesicle invasion in patients without lymph node metastases. Patients with seminal vesicle invasion had a significantly worse prognosis than those with capsular penetration; peri-seminal vesicle invasion was associated with an intermediate risk of progression. Gleason grade, surgical margins and seminal vesicle invasion were all independent predictors of progression in a multivariate analysis, whereas tumor volume was not. In patients with seminal vesicle invasion there was a trend for surgical margins and Gleason grade to predict progression; with tumor volume there was none. Our study demonstrates that the definition of seminal vesicle invasion should be restricted to tumors showing infiltration into the muscular wall of the seminal vesicle. Our study further demonstrates that when assessing the ability of new prognostic variables to predict prognosis of patients with seminal vesicle invasion, margins of resection and Gleason grade should be considered.
前列腺癌病理分期的一致性问题中，精囊侵犯这一问题受到的关注相对较少。一些研究将精囊周围软组织中的肿瘤定义为精囊侵犯，而另一些研究则将精囊侵犯等同于肿瘤侵犯精囊的肌壁。与包膜穿透相比，精囊侵犯的预后意义也存在争议，以及精囊侵犯是否是独立于肿瘤体积和分级的预后不良预测因素。我们评估了115例确诊有包膜穿透、16例有精囊周围侵犯和45例有精囊侵犯且无淋巴结转移的患者。有精囊侵犯的患者预后明显比有包膜穿透的患者差；精囊周围侵犯与中等进展风险相关。在多变量分析中，Gleason分级、手术切缘和精囊侵犯都是进展的独立预测因素，而肿瘤体积则不是。在有精囊侵犯的患者中，手术切缘和Gleason分级有预测进展的趋势；肿瘤体积则没有。我们的研究表明，精囊侵犯的定义应限于显示浸润到精囊肌壁的肿瘤。我们的研究进一步表明，在评估新的预后变量预测有精囊侵犯患者预后的能力时，应考虑手术切缘和Gleason分级。
