Epstein J I, Pound C R, Partin A W, Walsh P C
Department of Pathology and the James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
J Urol. 1998 Jul;160(1):97-100; discussion 101.
The long-term prognosis of men with Gleason score 7 adenocarcinoma of the prostate is uncertain.
We studied 488 men whose radical prostatectomy specimen showed Gleason score 7 tumor without involvement of the seminal vesicles or lymph nodes. Of the 400 men without progression 318 had been followed for 2 years or more and 93 for 7 years or more.
Cases of organ confined disease and negative margins regardless of extent of extraprostatic extension had roughly similar and better prognoses than cases of focal and established extraprostatic extension with positive margins. The greater influence of margin status on progression (p <0.0001) compared to extent of extraprostatic extension (p = 0.023) was evidenced in the multivariate analysis. Of 30 men with established extraprostatic extension and positive margins 6 (20%) had progression to distant metastases, which was similar to 14 of 58 (24%) without established extraprostatic extension and positive margins. There was no difference in response to radiotherapy between men with established extraprostatic extension and positive margins compared to the other cases.
Margins status greatly influences the risk of progression in men with Gleason score 7 tumors. Among men with Gleason score 7 tumors, except for those with established extraprostatic extension and positive margins, more than 50% appear to be cured at long-term followup. Because of the high risk of progression in patients with positive margins, clinical studies of adjuvant therapy in this population appear warranted.
Gleason评分7分的前列腺腺癌男性患者的长期预后尚不确定。
我们研究了488例根治性前列腺切除术标本显示Gleason评分7分肿瘤且未累及精囊或淋巴结的男性患者。在400例无疾病进展的患者中，318例随访了2年或更长时间，93例随访了7年或更长时间。
无论前列腺外扩展程度如何，切缘阴性的器官局限性疾病患者的预后大致相似且优于切缘阳性的局灶性和已确定的前列腺外扩展患者。多变量分析表明，切缘状态对疾病进展的影响（p<0.0001）大于前列腺外扩展程度（p = 0.023）。在30例已确定前列腺外扩展且切缘阳性的患者中，6例（20%）发生远处转移进展，这与58例未确定前列腺外扩展且切缘阳性的患者中的14例（24%）相似。已确定前列腺外扩展且切缘阳性的男性患者与其他病例相比，对放疗的反应没有差异。
切缘状态对Gleason评分7分肿瘤男性患者的疾病进展风险有很大影响。在Gleason评分7分的肿瘤男性患者中，除了那些已确定前列腺外扩展且切缘阳性的患者外，超过50%的患者在长期随访中似乎已治愈。由于切缘阳性患者的疾病进展风险较高，因此对该人群进行辅助治疗的临床研究似乎是必要的。
