Pettaway C A
Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Tech Urol. 1998 Mar;4(1):35-42.
Current dilemmas for physicians managing patients with localized prostate cancer include deciding: (1) which patients need aggressive treatment; (2) what treatment options are best for a given patient; and (3) what treatment outcomes can be expected. This article reviews our ability to prognosticate outcome (including pathological stage and disease-free survival rate) in patients with clinically localized adenocarcinoma of the prostate (AJCC, stage T1-T2. N0, M0) subsequent to analysis of several contemporary series involving patients treated with radical prostatectomy and external-beam radiation therapy. Pretherapy prostate-specific antigen (PSA) level (< or =4 ng/mL or >20 ng/mL) and Gleason score (< or =4 or > or =8) as individual variables provide independent prognostic information for only a subset of patients undergoing radical prostatectomy and external-beam radiation therapy. Pathological stage is the most powerful predictor of outcome following radical prostatectomy, and its prediction (organ-confined vs. seminal vesicle or lymph node involvement) is aided by knowledge of clinical stage, Gleason score, and PSA level. Planned systematic biopsies also provide useful prognostic information for the prediction of pathological stage and tumor volume, as well as providing additional tissue for pathological assessment of tumor heterogeneity. Several novel markers of biological aggressiveness are associated with critical steps of the metastatic cascade (growth, invasion, angiogenesis, and resistance to apoptosis) and include the p53 tumor suppressor gene, the bcl-2 proto-oncogene, markers of increased proliferation (Ki-67), apoptosis, and angiogenesis (microvessel density). Their evaluation in clinical specimens is currently being used to prognosticate outcome. Current clinical and pathological parameters provide a "ballpark" estimate of outcome for patients with clinically localized prostate cancer. Further elucidation of the critical molecular events associated with prostate cancer progression and metastasis should help in identifying molecular markers that more accurately predict the prognosis for an individual patient with clinically localized prostate cancer.
当前，负责治疗局限性前列腺癌患者的医生面临的困境包括做出以下决定：（1）哪些患者需要积极治疗；（2）对于特定患者而言，哪种治疗方案最佳；（3）可以预期何种治疗结果。本文回顾了在分析了多个涉及接受根治性前列腺切除术和外照射放疗的患者的当代系列研究之后，我们对临床局限性前列腺腺癌（美国癌症联合委员会 [AJCC] 分期T1-T2、N0、M0）患者的预后（包括病理分期和无病生存率）进行预测的能力。治疗前前列腺特异性抗原（PSA）水平（≤4 ng/mL 或＞20 ng/mL）和 Gleason 评分（≤4 或≥8）作为个体变量，仅为一部分接受根治性前列腺切除术和外照射放疗的患者提供独立的预后信息。病理分期是根治性前列腺切除术后预后的最有力预测指标，借助临床分期、Gleason 评分和 PSA 水平的知识有助于对其进行预测（器官局限性与精囊或淋巴结受累情况）。计划中的系统活检也为病理分期和肿瘤体积的预测提供有用的预后信息，同时还能提供额外组织用于肿瘤异质性的病理评估。几种新的生物学侵袭性标志物与转移级联反应的关键步骤（生长、侵袭、血管生成和抗凋亡）相关，包括 p53 肿瘤抑制基因、bcl-2 原癌基因、增殖增加标志物（Ki-67）、凋亡和血管生成标志物（微血管密度）。目前正在临床标本中对它们进行评估以预测预后。当前的临床和病理参数为临床局限性前列腺癌患者的预后提供了一个“大致”估计。进一步阐明与前列腺癌进展和转移相关的关键分子事件，应有助于识别能更准确预测个体临床局限性前列腺癌患者预后的分子标志物。
