Increasing incidence of minimal residual cancer in radical prostatectomy specimens
Increasing incidence of minimal residual cancer in radical prostatectomy specimens
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DOI：
10.1097/00000478-199702000-00006
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发表时间：
1997-02-01
影响因子：
5.6
通讯作者：
Epstein, JI
中科院分区：
文献类型：
--
作者：
DiGiuseppe, JA;Sauvageot, J;Epstein, JI
经活检证实为腺癌的男性根治性乳腺切除术标本中的残留癌有时可能难以识别，甚至不可能识别。虽然这一发现最近被描述为“微小残留癌”或“消失癌现象”，但在外科病理学实践中没有关于这种现象发生率的数据。我们评估了1988年至1995年间在约翰霍普金斯医院进行的3,038例连续根治性前列腺切除术，排除了有经尿道切除术史、既往接受过促黄体生成素释放激素激动剂治疗、局灶性Gleason分级4或5、包膜穿透或手术切缘阳性的病例。在该组中，确定了84例极轻微或无残留癌的病例。在这些病例中，有60例的残留癌是“难以发现”（平均总体积，0.03 cc;范围，0.01-0.08 cc）;在20例病例中，残留癌被归类为“微小”（平均总体积，0.07 cc;范围，0.03-0.13 cc）。在4例病例中，未发现残留癌，包括2例经针吸活检确诊为癌症，1例经诊断性针吸活检复查仅发现高级别前列腺上皮内瘤变，1例经分子分析证实针吸活检标本标记错误。微小残留癌的年发病率从1988年的0.5%增加到1993年的4%，自1993年以来开始稳定在3%至4%（增加趋势p = 0.0016）。这些数据证实了一般的印象，即对男性进行更警惕的前列腺癌筛查，在根治性前列腺切除术中几乎没有或没有残留癌症的癌症增加。
Residual cancer in radical prostatectomy specimens from men with biopsy-proven adenocarcinoma occasionally may be difficult, or even impossible, to identify. Although this finding was recently described as ''minimal residual cancer'' or the ''vanishing cancer phenomenon,'' there are no data on the incidence of this phenomenon in surgical pathology practice. We evaluated 3,038 consecutive radical prostatectomies performed at the Johns Hopkins Hospital between 1988 and 1995, excluding cases with a history of transurethral resection, prior therapy with a luteinizing hormone-releasing hormone agonist, focal Gleason grade 4 or 5, capsular penetration, or a positive surgical margin. Of this group, 84 cases with minimal or no residual cancer were identified. In 60 of these cases, residual cancer was ''difficult to find'' (mean total volume, 0.03 cc; range, 0.01-0.08 cc); in 20 cases, residual cancers were classified as ''minute'' (mean total volume, 0.07 cc; range, 0.03-0.13 cc). In four cases, no residual cancer could be identified, including two cases in which the diagnosis of cancer on needle biopsy was confirmed, one case in which review of the diagnostic needle biopsy revealed only high-grade prostatic intraepithelial neoplasia, and one case in which molecular analysis demonstrated mislabeling of the needle biopsy specimen. The annual incidence of minimal residual cancer increased from 0.5% in 1988 to 4% in 1993 and has begun to plateau at 3 to 4% since 1993 (p = 0.0016 for increasing trend). These data confirm the general impression that with more vigilant screening of men for prostate cancer, there has been an associated increase in cancer with little or no residual cancer at radical prostatectomy.