摘要
目的分析前列腺穿刺活检单针阳性患者行根治性前列腺切除术后的病理特征。
方法回顾性分析2012年7月至2017年6月我院收治的164例穿刺活检单针阳性的前列腺癌患者的临床资料。年龄41～82岁，平均66.3岁。术前PSA 0.7～59.5 ng/ml，平均12.3 ng/ml。穿刺Gleason评分6分113例，3＋4分21例，4＋3分18例，≥8分12例。临床分期cT1期71例，cT2期92例，cT3期1例。患者均行根治性前列腺切除术。将患者按年龄、术前PSA水平、穿刺Gleason评分和临床分期等因素进行分组，比较各组患者的临床病理特征的差异。
结果164例中，术后病理Gleason评分6分67例，3＋4分52例，4＋3分24例，≥8分11例；术后病理未发现癌灶残留（pT0期）10例，肿瘤包膜外浸润（pT3a期）3例，侵犯精囊（pT3b期）5例。切缘阳性24例。相对于穿刺Gleason评分，根治标本Gleason评分降低24例，不变77例，升高53例。年龄〈70岁与≥70岁者比较，术后病理特征差异无统计学意义（P〉0.05）。PSA≥10ng/ml较PSA〈10 ng/ml者术后Gleason评分≥7分的比例增加[66.2%（51/77）与41.4%（36/87），P〈0.05]；不同穿刺Gleason评分间术后病理分期差异有统计学意义（P＝0.002），并且穿刺Gleason评分6分相对于其他Gleason评分患者，术后pT0期的比例较高[8.8%（10/113）与0，P ＝ 0.09]。cT1期中pT0期患者比例较cT2期的比例明显升高[11.3%（8/71）与2.8%（2/92），P ＝ 0.02]，而cT1期术后Gleason评分升级的比例较cT2期明显降低[23.9%（17/71）与39.1%（36/92），P〈0.05]。
结论前列腺穿刺单针阳性并不能作为前列腺癌低风险的指标。对于大多数单针阳性前列腺癌患者需积极治疗，但对部分患者需警惕pT0期前列腺癌的可能。
ObjectiveTo evaluate the clinical and pathological features of patients with prostate cancer who were diagnosed by single positive core biopsy and treated by radical prostatectomy （RP）.
MethodsBetween July 2012 and June 2016, 164 patients with prostate cancer diagnosed by single positive core biopsy underwent RP.The mean age was 66.3 years old （ranged 41-82 years old）, and the mean PSA level was 12.3 ng/ml （ranged 0.6-59.5 ng/ml）. The biopsy Gleason score showed 6 scores in 113 cases, 3＋ 4=7 scores in 21 cases, 4＋ 3=7 scores in 18 cases, ≥8 scores in 12 cases.Clinical stage was cT1 in 71 cases, cT2 in 92 cases, and cT3 in 1 case. The patients were divided into subgroups according to age, preoperative PSA level, biopsy Gleason score and clinical stage, and the pathological results were compared among these subgroups.
ResultsOf the 164 patients, 67 cases had Gleason score ≤6, 52 cases Gleason score 3＋ 4=7, 24 case Gleason score 4＋ 3=7, and 11 cases Gleason score ≥8. Ten patients had pT0 disease according to the RP specimen, 3 had extraprostatic extensions, 5 had seminal vesicle invasions, and 24 had positive surgical margins. Compared to the biopsy, the Gleason score of RP specimens was higher in 53 cases, concordant in 77 cases, and lower in 24 cases. There was no significant difference in the postoperative pathological features between the age group 〈70 years and the group ≥70 years. Compared with PSA〈10 ng/ml, the likelihood of postoperative Gleason score 〉7 was significantly increased in PSA ≥10 ng/ml group [41.4%（36/87） vs. 66.2%（51/77）, P〈0.05]. When the biopsy Gleason score was divided into four groups （6, 3＋ 4=7, 4＋ 3=7, ≥8）, there were significant differences in postoperative pathological stages among the four groups （P〈0.05）, and the patients with biopsy Gleason score 6 were more likely to have no residual cancer （stage T0） when compared with other Gleason scores [8.8%（10/113） vs. 0, P=0.09]. The probability of no residual cancer
作者
徐毅
毛祺琦
刘犇
郑祥义
谢立平
Xu Yi; Mao Qiqi; Liu Ben; Zheng Xiangyi; Xie Liping(Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2018年第10期757-760,共4页
Chinese Journal of Urology
关键词
前列腺癌
活检
单针阳性
病理分期
Prostatic neoplasms
Biopsy
Single positive core
Pathological stage
