摘要
目的探讨年龄≥65岁临床低危型前列腺癌患者行前列腺根治性切除术后病理Gleason评分升级的危险因素。方法回顾性分析485例来自2015年1月至2019年3月全国多中心PC-follow数据库中5家中心的年龄≥65岁的临床低危型前列腺癌患者,收集患者确诊时年龄、前列腺特异性抗原(PSA)、MRI前列腺影像报告、穿刺Gleason评分、手术方式、穿刺方式、切缘阳性及突破包膜等信息,比较患者术前穿刺病理Gleason评分与术后病理Gleason评分的差异,使用单因素和多因素Logistic回归分析评估引起临床低危型前列腺癌根治性切除术后病理升级的危险因素。结果穿刺Gleason评分3+3=6分的485例有261(53.8%)出现术后病理升级,术后Gleason评分升级的患者中,Gleason评分升级为7分228例(87.4%),升级为8分22例(8.4%),升级为9分以上11例(4.2%)。术前PSA水平、盆腔MRI报告阳性、穿刺针数阳性率越高,Gleason评分升级率越高。病理升级组与病理非升级组的术后突破包膜(27.2%和12.5%,P<0.001)及切缘阳性(25.2%和17.4%,P=0.036)发生率差异有统计学意义。多因素分析表明术前PSA水平、穿刺阳性针数百分比、穿刺病理Gleason评分、盆腔MRI为前列腺癌的独立性预测指标。结论对存在病理Gleason评分升级高危因素的≥65岁的临床低危型前列腺癌患者,必要时应进行重复穿刺,及时调整治疗方案。
Objective To investigate the risk factors for Gleason score upgrading after radical prostatectomy in clinical low risk prostate cancer patients aged≥65 years.Methods A total of 485 clinical low-risk prostate cancer patients aged≥65 years at five centers of the national multi-center PC-follow database from January 2015 to March 2019 were retrospectively analyzed.Data including age at diagnosis,prostate specifie antigen(PSA),MRI prostate imaging,puneture Gleason score.operation method.puncture method,positive incision margin and capsule penetration were collected.Differences in Gleason scores before and after operation were compared,and the risk factors for Gleason score upgrading after radical resection were evaluated by univariate and multivariate Logistic regression analysis.Results Of 485 patients with a puncture Gleason score of 3+3=6.261(53.8%)cases had postoperative pathological upgrading,in whom 228(87.4%)cases had Gleason score upgrading of 7.22(8.4%)had Gleason score upgrading of 8,and 11(4.2%)had Gleason score upgrading of 9 or more.The rate of Gleason score upgrading was elevated with increased preoperative PSA levels。positive pelvic MRI.and higher positive rates of puncture biopsy.The incidences of postoperative capsule penetration(27.2%vs.12.5%.P<0.001)and positive incision margin(25.2%vs.17.4%.P=0.036)had statistically significant differences between the pathologically upgraded group and the pathologically non upgraded group.Multivariate analysis showed that preoperative PSA level,.percentage of positive puncture biopsies.biopsy Gleason score and pelvic MRI were independent predictors of prostate cancer.Conclusions For clinical low-risk prostate cancer patients aged≥65 years with high risk factors for Gleason score upgrading,repeated biopsies should be carried out when necessary and the treatment plan should be adjusted accordingly.
作者
程万里
逄城
宋新达
付春龙
侯惠民
周利群
马璐林
高旭
贺大林
王建业
刘明
Cheng Wanli;Pang Cheng;Song Xinda;Fu Chunlong;Hou Hunmin;Zhou Liqun;Ma Lulin;Gao Xu;He Dalin;Wang Jianye;Liu Ming(Graduate School of Peking Union Medical College,Beijing 100730,China;Department of Urology,Beijing Hospital,National Geriatric Center,Institute of Geriatrics of Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Urology,Peking University First Hos pital,Beijing 100340,China;Department of Urology,Peking University Third Hospital,Beijing 100161,China;De partment of Urology,Changhai Hospital,the Second Military Medical University,Shanghai 200433,China;Department of Urology,the First Affiliated Hospital,Xi'an Medical University.Xi'an 710061,China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2020年第9期1059-1062,共4页
Chinese Journal of Geriatrics
基金
国家重点研发计划专项(2017YFC0840102)
重大协同创新项目-重大前沿研究(2018-12M-1-002)
首都临床特色应用研究(BJ-2017-055)
121工程项目(BJ-2018-090)
北京医院博士启动基金(BJ-2018-029)。
关键词
前列腺肿瘤
病理学
危险因素
Prostate neoplasms
Cxleason score
Pathology
Risk faetors
