Epstein J I, Carmichael M, Partin A W, Walsh P C
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Urol. 1993 Jun;149(6):1478-81. doi: 10.1016/s0022-5347(17)36421-2.
Tumor volume has been shown to be proportionate to Gleason grade, capsular penetration, seminal vesicle invasion, lymph node metastases and capsular margins of resection. Because these variables are often interrelated, it is crucial to determine which of these parameters provides independent prediction of prognosis in prostate cancer. The current study analyzed 185 men who underwent radial retropubic prostatectomy for clinical stage B adenocarcinoma of the prostate. Patients with seminal vesicle invasion or lymph node metastases were excluded, since these findings are almost invariably associated with progression. All patients were followed for a minimum of 5 years after radical prostatectomy. Only 2 men received postoperative adjuvant therapy. At 5 years after radical prostatectomy 58 men (31%) experienced progression, defined by either an elevated postoperative serum prostate specific antigen level, local recurrence or distant metastases. Although by themselves capsular penetration, tumor volume and per cent of the prostate involved by tumor predicted progression, in a stepwise regression analysis they did not provide independent prognostic information. In this multivariate analysis Gleason score was the best predictor of progression (p < 0.0001); surgical margin was the only other variable that enhanced prediction, although it was less influential than grade (p = 0.018). This strong predictability provided by Gleason score was all the more impressive given the relatively few patients in our study with either low or high grade tumor. Although an accurate preoperative assessment of tumor volume remains desirable for the management of patients with prostate cancer, our study demonstrates that measurement of tumor volume in radical prostatectomy specimens need not be performed as part of the routine pathological analysis of radical prostatectomy specimens, since it does not provide additional information beyond that of Gleason score and the status of capsular margins.
肿瘤体积已被证明与 Gleason 分级、包膜侵犯、精囊侵犯、淋巴结转移及切除的包膜边缘成比例。由于这些变量常常相互关联，因此确定这些参数中哪一个能独立预测前列腺癌的预后至关重要。本研究分析了 185 例行耻骨后根治性前列腺切除术治疗临床 B 期前列腺腺癌的男性患者。精囊侵犯或淋巴结转移的患者被排除，因为这些发现几乎总是与疾病进展相关。所有患者在根治性前列腺切除术后至少随访 5 年。只有 2 名男性接受了术后辅助治疗。在根治性前列腺切除术后 5 年，58 名男性（31%）出现疾病进展，定义为术后血清前列腺特异性抗原水平升高、局部复发或远处转移。虽然包膜侵犯、肿瘤体积及肿瘤累及前列腺的百分比自身可预测疾病进展，但在逐步回归分析中，它们并未提供独立的预后信息。在这项多变量分析中，Gleason 评分是疾病进展的最佳预测指标（p < 0.0001）；手术切缘是唯一能增强预测的其他变量，尽管其影响力小于分级（p = 0.018）。鉴于我们研究中低级别或高级别肿瘤患者相对较少，Gleason 评分所提供的这种强大预测性更令人印象深刻。虽然对于前列腺癌患者的管理而言，准确的术前肿瘤体积评估仍然是可取的，但我们的研究表明，在根治性前列腺切除标本的常规病理分析中无需测量肿瘤体积，因为它除了 Gleason 评分和包膜边缘状态外，并未提供额外信息。
