前列腺癌根治术后病理升级的临床危险因素分析

doi:10.3969/j.issn.1671-167X.2016.04.007

摘要/Abstract

摘要：

目的：探讨前列腺癌根治术后病理升级的临床危险因素。方法：回顾性分析2011年7月至2014年10月160例经前列腺穿刺活检确诊为前列腺腺癌行根治性手术患者的临床资料。患者年龄57~82岁（平均71.6岁），前列腺特异性抗原（prostate specific antigen，PSA）0.31~40.32 μg/L（平均11.29 μg/L），体重指数（body mass index，BMI）16.41~32.04 kg/m2（平均23.63 kg/m2）。前列腺体积（prostate volume，PV）9.52~148.46 mL（平均40.19 mL），其中PV<30 mL者60例（37.5%）、30~50 mL者48例（30.0%）、≥50 mL者52例（32.5%）。临床分期≤T2a、T2b和≥T2c者分别为91例（56.9%）、49例（30.6%）和20例（12.5%），穿刺Gleason评分为6、7和≥8者分别为69例（43.1%）、67例（41.9%）和24例（15.0%）。收集患者确诊时年龄、BMI、PSA、PV、穿刺针数、穿刺阳性百分数、临床分期、穿刺Gleason评分等，比较术前穿刺病理Gleason评分与术后大体病理Gleason评分，使用单因素和多因素Logistic回归分析评估引起前列腺癌根治术后病理升级的危险因素。结果：大体病理与术前穿刺病理Gleason评分一致者82例（51.3%），较术前穿刺病理升级者49例（30.6%），较术前穿刺病理降级者29例（18.1%）。术后病理升级的单因素分析中，患者年龄、BMI、穿刺前PSA、临床分期、穿刺针数均无统计学意义（P>0.05），前列腺体积（P=0.035）和穿刺病理Gleason评分（P=0.043）具有统计学意义，进入多因素分析。多因素Logistic回归分析显示，穿刺Gleason评分低（P=0.035）和前列腺体积小（P=0.013）是前列腺癌根治术后大体病理升级的独立危险因素。结论：前列腺癌根治术后病理Gleason评分较术前穿刺病理存在升级现象，前列腺体积小和穿刺Gleason评分低是其独立危险因素。

关键词: 前列腺肿瘤, 肿瘤分级, 前列腺切除术

Abstract:

Objective： To assess the discrepancy between preoperative needle biopsy (NB) Gleason score and pathological specimen Gleason score (GS) after radical prostatectomy, and to explore the risk factors of postoperative upgrading of GS. Methods: We retrospectively evaluated 160 patients who suffered from biopsy proved prostatic carcinoma and performed radical prostatectomy. Age of the patients was 57-82 years, with the average age of 71.6; prebiopsy prostate specific antigen (PSA) was 0.31-40.32 μg/L，with the average PSA of 11.29 μg/L; body mass index (BMI) was 16.41-32.04 kg/m2, with the average BMI of 23.63 kg/m2; prostate volume (PV) was 9.52-148.46 mL, with the average PV of 40.19 mL. All the patients included in the study had complete information for clinical variables, including age, BMI, prebiopsy PSA level, PV, number of biopsy cores obtained, percentage, clinical stage, and biopsy GS. Grading of NB Gleason score was compared with their corresponding radical prostatectomy specimens, and the discrepancy between the NB and prostatectomy specimens GS assessed. Upgrading was defined as any increase in the pathological GS over that of the biopsy GS as a total sum of primary and secondary grades or a change in the order of primary and secondary grades towards higher ones. Univariable and multivariable Logistic regression analyses were used to identify predictors of pathological grading changes. Results: Of the 160 patients, the specimen GS was upgraded in 49 (30.6%) patients and remained with no change in 82 (51.3%) patients. Univariate and multivariate regression analysis showed that prostate volume and biopsy GS were independent predictors with postoperative upgrading of GS. Age, BMI, PSA before needle biopsy, clinical stage and needle number showed no statistical significance (P＞0.05). Conclusion: Lower biopsy GS and smaller prostate volume are increased risks for clinically upgrading of GS after radical prostatectomy. This fact should be kept in mind when deciding on therapy decisions for patients with prostate cancer.

Key words: Prostatic neoplasms, Neoplasm grading, Prostatectomy

中图分类号:

R737.25

左强，张帆，黄毅，马潞林，陆敏，卢剑. 前列腺癌根治术后病理升级的临床危险因素分析[J]. 北京大学学报(医学版), 2016, 48(4): 603-606.

ZUO Qiang, ZHANG Fan, HUANG Yi, MA Lu-lin, LU Min, LU Jian. Clinically predictive factors of Gleason score upgrading in patients after radical prostatectomy[J]. Journal of Peking University(Health Sciences), 2016, 48(4): 603-606.

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