Is biopsy Gleason score independently associated with biochemical progression following radical prostatectomy after adjusting for pathological Gleason score?
Is biopsy Gleason score independently associated with biochemical progression following radical prostatectomy after adjusting for pathological Gleason score?
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DOI：
10.1016/j.juro.2006.08.014
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发表时间：
2006-12-01
影响因子：
6.6
通讯作者：
Freedland, Stephen J.
中科院分区：
文献类型：
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作者：
Fitzsimons, Nicholas J.;Presti, Joseph C., Jr.;Freedland, Stephen J.
目的：活检Gleason评分已知与根治性前列腺切除术后前列腺特异性抗原失败相关。然而，目前尚不清楚当病理Gleason评分已知时，它是否仍然与手术后的结果相关。材料和方法：我们确定了活检Gleason评分和生化进展之间的相关性，校正了术前和术后特征，包括病理Gleason评分，在1988年至2005年期间，在共享平等获取区域癌症医院数据库研究组数据库中，有931名男性接受了根治性乳房切除术。Gleason评分作为2 - 6、3 + 4和4 + 3或更大的分类变量进行检查。较高的活检Gleason评分与囊外扩张呈正相关（p < 0.001），手术切缘阳性（p < 0.001）、精囊浸润（p < 0.001）、淋巴结阳性（p < 0.001）和生化进展（log rank p < 0.001）。仅调整术前特征后，与活检Gleason 6或更低相比，活检Gleason 3 + 4和4 + 3或更高与生化进展风险增加相关（p = 0.001和. < 0.001）。在进一步调整多种病理学特征后，包括病理学Gleason评分，较高的活检Gleason评分与进展之间的关联几乎没有变化，因为活检Gleason 3 + 4和4 + 3或更高的男性更有可能经历进展（分别为p = 0.001和< 0.001）。此外，当按病理学Gleason评分分层时，较高的活检Gleason评分与每个病理学Gleason评分类别中生化进展风险增加相关（对数秩和检验P <0.05）。
Purpose: Biopsy Gleason score is known to be associated with prostate specific antigen failure following radical prostatectomy. However, it is unclear whether it remains associated with outcome after surgery when the pathological Gleason score is known.Materials and Methods: We determined the association between biopsy Gleason score and biochemical progression after correcting for preoperative and postoperative characteristics, including pathological Gleason score, in 1,931 men treated with radical prostatectomy between 1988 and 2005 in the Shared Equal Access Regional Cancer Hospital Database Study Group database. Gleason score was examined as a categorical variable of 2 to 6, 3 + 4 and 4 + 3 or greater.Results: Higher biopsy Gleason scores were positively associated with extracapsular extension (p < 0.001), positive surgical margins (p < 0.001), seminal vesicle invasion (p < 0.001), positive lymph nodes (p < 0.001) and biochemical progression (log rank p < 0.001). After adjusting for only preoperative characteristics biopsy Gleason 3 + 4 and 4 + 3 or greater were associated with increased risk of biochemical progression compared to biopsy Gleason 6 or less (p = 0.001 and. < 0.001, respectively). After further adjusting for multiple pathological characteristics, including pathological Gleason score, the association between higher biopsy Gleason score and progression was little changed, in that men with biopsy Gleason 3 + 4 and 4 + 3 or greater were significantly more likely to experience progression (p = 0.001 and < 0.001, respectively). Furthermore, when stratified by pathological Gleason score, higher biopsy Gleason scores were associated with an increased risk of biochemical progression in each pathological Gleason score category (log rank p