Central zone carcinoma of the prostate gland: A distinct tumor type with poor prognostic features
Central zone carcinoma of the prostate gland: A distinct tumor type with poor prognostic features
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DOI：
10.1016/j.juro.2008.01.017
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发表时间：
2008-05-01
影响因子：
6.6
通讯作者：
Garrett, Kerryn L.
中科院分区：
文献类型：
--
作者：
Cohen, Ronald J.;Shannon, Beverley A.;Garrett, Kerryn L.
目的：前列腺中央区是一个很少与癌相关的区域。据我们所知，以前还没有将中心区肿瘤与起源于前列腺外周或转移区的癌进行比较。材料与方法：回顾性分析1998年10月至2006年12月在我院接受根治性前列腺切除术的2010例患者，以确定肿瘤的区域性起源。中心带癌的特征，并与其他区域的肿瘤进行比较。结果：1703例中，共2494例肿瘤确定了区域性起源。63例（2.5%）肿瘤为中央区起源，其中59例为中央区起源。63代表主要肿瘤。对726例确定子集的比较分析显示，中心区癌明显比外周区或过渡区癌更具侵袭性，其囊外延伸、精囊浸润和手术切缘阳性的风险要大得多。从腺体中逸出通常经由射精管和精囊。Kaplan-Meier分析证实，前列腺切除术后生化失败的概率是其他区域肿瘤的两倍，失败率要快得多。多因素Cox回归分析发现Gleason分级、阳性边缘、囊外延伸、肿瘤体积和术前血清前列腺特异性抗原是导致预后不良的主要因素，而不是特定的区域性起源。结论：据我们所知，本研究首次提供了中央区癌的特征和比较分析，确定这些肿瘤是一种罕见但高度侵袭性的前列腺癌，与其他区域的肿瘤相比，其腺体扩散途径不同。术前鉴定目前由于避免活检针对中心区域而受到阻碍。然而，如果术前认识到，积极的干预可能会改善目前暗淡的前景。
Purpose: The central zone of the prostate gland is a region rarely associated with carcinoma. To our knowledge central zone tumors have not previously been compared to carcinoma originating in the peripheral or transition zone of the prostate gland.Materials and Methods: All 2,010 radical prostatectomy cases seen at our institution from October 1998 to December 2006 were reviewed to identify tumor zonal origin. Central zone carcinoma was characterized and compared with tumors of other zones.Results: Zonal origin was determined in a total of 2,494 tumors in 1,703 cases. Of the tumors 63 (2.5%) were of central zone origin with 59 of the. 63 representing the index or main tumor. Comparative analysis of a defined subset of 726 cases showed that central zone cancers were significantly more aggressive than peripheral or transition zone cancers with a far greater risk of extracapsular extension, seminal vesicle invasion and positive surgical margins. Escape from the gland was often via the ejaculatory ducts and seminal vesicles. Kaplan-Meier analysis confirmed that the probability of post-prostatectomy biochemical failure was double that of tumors of the other zones with a far more rapid rate of failure. Multivariate Cox regression analysis identified Gleason grade, positive margins, extracapsular extension, tumor volume and preoperative serum prostate specific antigen as the major contributors to this poor prognosis, rather than specific zonal origin.Conclusions: To our knowledge this study provides the first characterization and comparative analysis of central zone carcinoma, identifying these tumors as a rare but highly aggressive form of prostate carcinoma with a distinct route of spread from the gland that contrasts with tumors of other zones. Preoperative identification is currently hampered by the avoidance of biopsy targeting the central zone. However, if recognized preoperatively, aggressive intervention may possibly improve the currently bleak outlook.