Prostate Carcinoma Grade and Length But Not Cribriform Architecture at Positive Surgical Margins Are Predictive for Biochemical Recurrence After Radical Prostatectomy
Prostate Carcinoma Grade and Length But Not Cribriform Architecture at Positive Surgical Margins Are Predictive for Biochemical Recurrence After Radical Prostatectomy
复制标题
DOI：
10.1097/pas.0000000000001384
复制
发表时间：
2020-02-01
影响因子：
5.6
通讯作者：
van Leenders, Geert J. L. H.
中科院分区：
文献类型：
--
作者：
Hollemans, Eva;Verhoef, Esther I.;van Leenders, Geert J. L. H.
在接受根治性前列腺切除术治疗的前列腺癌患者中，高达40%的患者发生术后生化复发。原发肿瘤分级和筛状结构是临床结果的重要参数;然而，它们与手术切缘阳性的相关性尚未完全阐明。我们回顾了835例根治性乳腺癌切除术标本，并记录了原发肿瘤和阳性手术切缘的PT分期、手术切缘状态、分级组和筛状结构。临床病理参数和生化无复发生存期（BCRFS）作为终点。284例（34%）患者存在阳性手术切缘，中位累积长度为5.0 mm。46%的患者切缘分级组与原发肿瘤分级相同，42%的患者切缘分级组低于原发肿瘤分级组，12%的患者切缘分级组高于原发肿瘤分级组。在多因素分析中，边缘分级组在预测BCRFS方面优于原发肿瘤分级组。在原发性2级组患者中，56%的患者边缘有1级组疾病。多变量分析确定累积长度、边缘分级组和淋巴结转移是BCRFS的独立预测因子，而原发肿瘤的Gleason 4型、第三Gleason 5型和边缘筛状结构的百分比不是BCRFS的独立预测因子。总之，手术切缘阳性的分级组与原发性肿瘤分级的差异为54%，并且比原发性肿瘤分级更好地预测BCRFS。边缘的累积长度和肿瘤分级是BCRFS的独立预测因子，而边缘的筛状结构不是。
Postoperative biochemical recurrence occurs in up to 40% of prostate carcinoma patients treated with radical prostatectomy. Primary tumor grade and cribriform architecture are important parameters for clinical outcome; however, their relevance at positive surgical margins has not been completely elucidated yet. We reviewed 835 radical prostatectomy specimens and recorded pT-stage, surgical margin status, Grade Group, and cribriform architecture of the primary tumor and at positive surgical margins. Clinicopathologic parameters and biochemical recurrence-free survival (BCRFS) were used as endpoints. Positive surgical margins were present in 284 (34%) patients, with a median cumulative length of 5.0 mm. In 46%, the Grade Group at the margin was equal to the primary tumor grade, while being lower in 42% and higher in 12%. In multivariable analysis, Grade Group at the margin outperformed the Grade Group of the primary tumor in predicting BCRFS. Among primary Grade Group 2 patients, 56% had Grade Group 1 disease at the margin. Multivariable analysis identified cumulative length, Grade Group at the margin, and lymph node metastasis as independent predictors for BCRFS, while percentage Gleason pattern 4, tertiary Gleason pattern 5 of the primary tumor, and cribriform architecture at the margin were not. In conclusion, the Grade Group at the positive surgical margin was dissimilar to the primary tumor grade in 54% and better predicted BCRFS than the primary tumor grade. Cumulative length and tumor grade at the margin were independent predictors for BCRFS, whereas cribriform architecture at the margin was not.