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[活检在前列腺癌根治术前分期中的价值]

[Value of biopsies in staging of prostatic cancer before radical prostatectomy].

作者信息

Salomon L, Hoznek A, Lefrere-Belda M A, Bellot J, Chopin D, Abbou C C

机构信息

Service d'Urologie, CHU Henri Mondor, Créteil, France.

出版信息

Prog Urol. 1998 Dec;8(6):969-76.

PMID:9894255
Abstract

The diagnosis of prostate cancer is confirmed by histological examination of prostate biopsies. In cases of localized prostate cancer, in which radical prostatectomy can be proposed as curative treatment, these biopsies, directly reflecting the cancer, can provide important prognostic elements, by specifying the tumour staging, allowing better patient selection and guiding surgical techniques in order to improve the postoperative histological results either by decreasing the number of pT3 tumours (extraprostatic) or the positive resection margin rate. Only pejorative elements are a good indicator of extraprostatic spread of the tumour: a Gleason score greater than 7, the presence of extracapsular invasion, perineural invasion, seminal vesicle invasion, 66% of positive biopsies are in favour of extraprostatic tumour. In contrast, the presence of apparently favourable prognostic elements, such as a low Gleason score, one out of six positive biopsies, limited invasion of biopsies cannot confirm the presence of a minimally aggressive, intraprostatic tumour (pT2). Other prognostic criteria may be discovered in the future, which will confirm with greater precision the extraprostatic or intraprostatic nature of localized prostatic tumours.

摘要

前列腺癌的诊断通过前列腺活检的组织学检查来确认。在可将根治性前列腺切除术作为治愈性治疗方案的局限性前列腺癌病例中,这些活检直接反映癌症情况,通过明确肿瘤分期,可提供重要的预后因素,有助于更好地选择患者并指导手术技巧,从而通过减少pT3期(前列腺外)肿瘤数量或阳性切缘率来改善术后组织学结果。只有不良因素才是肿瘤前列腺外扩散的良好指标:Gleason评分大于7、存在包膜外侵犯、神经周围侵犯、精囊侵犯,66%的阳性活检结果提示肿瘤前列腺外侵犯。相反,存在明显有利的预后因素,如低Gleason评分、六分之一阳性活检结果、活检侵犯有限,也不能确定存在侵袭性最小的前列腺内肿瘤(pT2)。未来可能会发现其他预后标准,这将更精确地确定局限性前列腺肿瘤的前列腺外或前列腺内性质。

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