Upgrade in Gleason score between biopsy and radical prostatectomy pathology indicates poor outcomes in prostate cancer
Upgrade in Gleason score between biopsy and radical prostatectomy pathology indicates poor outcomes in prostate cancer
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活检和根治性前列腺切除术病理学之间格里森评分的升级表明前列腺癌的预后不佳
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Xin Gao
中科院分区：
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作者：
Zheng Chen;Jun Pang;Jue Wang;Min-Hua Lu;Hui-Juan Shi;Jian-Ning Chen;Hao Zhang;Qun-Xiong Huang;Fang-Jian Zhou;Wei-Peng Liu;Xian-Ning Yi;Hao-Yuan Lu;Hui-Jun Qian;Xian-Tao Zeng;Jiang-Gen Yang;Xing Zhou;Jiu-Min Liu;Jun Chen;Xin Gao
格里森评分(Gleason Score，GS)在前列腺癌的生物学判断中起着重要作用，但预后信息很少。选择2005-01/2013-03中国8所专科医院收治的前列腺活检和前列腺癌根治术患者966例，平均随访53个月。建立Kaplan-Meier曲线和多变量模型，比较GS升级和Gleason评分相同的患者术后生化复发/进展和死亡的风险。总体而言，331名患者(34.26%)在根治性前列腺切除术(RP)后经历了GS升级。我们发现，与一致性GS患者相比，GS升级患者的生化复发/临床进展/死亡/癌症特异性死亡率显著更高(P<；0.001)。根据活检GS分为3组(活检GS≤6例，GS=7例，GS≥8例)，GS升级组的生化复发率显著高于GS一致性组(P<；0.005)。在多变量模型中，仅在术前环境下，GS的改变是生化复发(2.01(1.45-2.80)，P=0.001)、进展(1.77(1.06-2.96)，P=0.003)和死亡(1.83(0.83-4.04)，P=0.036)的独立预测因素。与相应的一致性肿瘤相比，活检术和根治术后GS升高的患者表现出明显更具侵袭性的病理特征，并且在根治术后生化复发/进展和死亡的风险更高。
Gleason score (GS) plays an important role in determining the biology of prostate cancer but prognostic information is scanty. A total of 966 patients with paired biopsy and radical prostatectomy histology were enrolled from 8 academic hospitals in China from January 2005 to March 2013, with median follow-up of 53 months. Kaplan-Meier curves and multivariate models were generated to compare the GS upgrade to those in whom the Gleason score remains the same on the risk of postoperative biochemical recurrence/progression and death. Overall, 331 patients (34.26%) experienced a GS upgrade post Radical Prostatectomy (RP). We found that patients with upgraded GS experienced a significantly higher rate of biochemical recurrence/clinical progression/death/cancer-specific mortality compared to those with concordant GS (P<0.001). According to the biopsy GS, patients were divided into 3 groups (biopsy GS≤6, GS=7, and GS≥8), patients with upgraded GS suffered a significantly higher biochemical recurrence (P<0.005) than those with concordant GS in the 3 groups. In multivariate models, a change in GS was an independent predictor of biochemical recurrence (2.01 (1.45-2.80), P<0.001), progression (1.77 (1.06-2.96), P=0.003) and death (1.83 (0.83-4.04), P=0.036) in the preoperative setting only. Patients experiencing an upgrade in their GS between biopsy and post RP exhibited significantly more aggressive pathological features than corresponding concordant tumors, and a higher risk of biochemical recurrence/progression and death post RP.