Pathological parameters of radical prostatectomy for at clinical stages T1c versus T2 prostate adenocarcinoma: Decreased pathological stage and increased detection of transition zone tumors
Pathological parameters of radical prostatectomy for at clinical stages T1c versus T2 prostate adenocarcinoma: Decreased pathological stage and increased detection of transition zone tumors
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DOI：
10.1016/s0022-5347(05)64671-x
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发表时间：
2002-08-01
影响因子：
6.6
通讯作者：
Shappell, SB
中科院分区：
文献类型：
--
作者：
Jack, GS;Cookson, MS;Shappell, SB
目的：对前列腺癌根治术标本的研究表明，大多数检测到的前列腺特异性抗原(临床分期为T1c期)肿瘤具有临床意义。我们比较了3年期间T1c期和T2期前列腺癌根治术标本中肿瘤的位置和病理参数。资料与方法：1998年1月1日至2000年12月31日，范德比尔特大学共施行前列腺癌根治术417例，其中T1c期246例，T2期108例。共有37名患者因接受新辅助抗雄激素治疗而被排除在研究之外。结果：与T2期相比，T1c期肿瘤的Gleason评分明显降低，Gleason评分5分以上，Gleason评分6分、7分和8分以上的肿瘤占Gleason评分的百分比较低。它们的体积也明显较小，病理分期较低。在T1c期肿瘤中，77%是器官受限的，而T2期肿瘤中有62%是器官受限的。当采用小于0.2cc的体积标准时，临床意义不明显的肿瘤在T1c期与T2期相比没有统计学意义的增加(13%比7%)，但使用小于0.5cc的体积标准(22%比9%)时，临床意义不大的疾病在统计学上显著增加。T2期肿瘤无1例位于移行区，17%位于移行区和周围区，14%的T1c期肿瘤仅位于移行区，17%位于移行区和周围区。与周围区肿瘤相比，移行区T1c期肿瘤的Gleason评分较低，Gleason评分增加5分，Gleason评分6、7、8分以上的百分比较低。尽管移行区T1c期肿瘤明显大于外周区T1c期肿瘤，但病理分期较低，分别为94%和72%。结论：前列腺特异性抗原检测T1c期肿瘤的分级、分期和体积均低于T2期肿瘤。T1c期肿瘤分级较低至少部分是由于含有移行区肿瘤的Gleason 2型肿瘤的检出增加所致。尽管体积较大，T1c移行区肿瘤似乎更有利于器官受限和低级别肿瘤的发生率。如果这种移行区肿瘤被证明是生物学上不同的，改进的术前识别这些病变的策略可能会导致更保守的治疗建议。
Purpose: Studies of radical prostatectomy specimens have suggested that the majority of prostate specific antigen detected (clinical stage T1c) tumors are clinically significant. We compared tumor location and pathological parameters in the radical prostatectomy specimens of stages T1c versus T2 cases in a 3-year period. The percent of stage T1c disease represented a stable majority of patients undergoing treatment for clinically localized prostate cancer.Materials and Methods: From January 1, 1998 to December 31, 2000, 417 radical prostatectomies were performed at Vanderbilt University, including 246 for stage T1c and 108 for stage T2 disease. A total of 37 patients were excluded from study because of neoadjuvant antiandrogen treatment. Pathological parameters, including tumor location in the transition and/or peripheral zone, tumor Gleason grade, tumor stage, total tumor volume and surgical margins were compared in stages T1c and T2 cases, and in transition versus peripheral zone stage T1c tumors in completely embedded whole mount specimens.Results: In contrast to stage T2 lesions, stage T1c tumors were of significantly lower Gleason score with a higher percent of Gleason score 5 and lower percent of Gleason score 6, 7 and 8 or greater. They also had a significantly smaller volume and lower pathological stage. Of stage T1c tumors 77% were organ confined versus 62% of stage T2 tumors. There was no statistically significant increase in clinically insignificant neoplasms in stages T1c versus T2 cases (13% versus 7%) when using a volume criterion of less than 0.2 cc but a statistically significant increase in clinically insignificant disease was observed using a volume criterion of less than 0.5 cc (22% versus 9%). Whereas none of the T2 tumors were located in the transition zone and 17% were located in the transition and peripheral zones, 14% of stage T1c lesions were exclusively in the transition zone, with another 17% in the transition and peripheral zones. Compared with peripheral zone tumors transition zone stage T1c tumors had a lower Gleason score with an increase in Gleason score 5 and lower percent of Gleason score 6, 7 and 8 or greater. Although transition zone stage T1c lesions were significantly larger than peripheral zone stage T1c lesions, they had a lower pathological stage with 94% versus 72% organ confined.Conclusions: Prostate specific antigen detected stage T1c tumors had a lower grade, stage and volume than stage T2 tumors during the same period. Lower tumor grade in stage T1c cases is due at least in part to the increased detection of Gleason pattern 2 containing transition zone tumors. Despite the larger size, T1c transition zone tumors appear to be more favorable with higher rates of organ confined and lower grade tumors. If such transition zone tumors prove to be biologically distinct, improved strategies to identify these lesions preoperatively may result in more conservative treatment recommendations.