Does the completeness of prostate sampling predict outcome for patients undergoing radical prostatectomy?: Data from the CaPSURE database
Does the completeness of prostate sampling predict outcome for patients undergoing radical prostatectomy?: Data from the CaPSURE database
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DOI：
10.1016/s0090-4295(00)00705-6
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发表时间：
2000-09-01
期刊：
影响因子：
2.1
通讯作者：
Carroll, PR
中科院分区：
文献类型：
--
作者：
Grossfeld, GD;Chang, JJ;Carroll, PR
目标。为了确定更完整的根治性前列腺切除术(RP)标本样本是否能更好地预测手术后的结果。我们回顾了在CaPSURE(前列腺癌患者的纵向登记)中登记的1383名接受RP的患者的病理报告。只有当整个标本被提交进行分析，并且切片间隔在0.5厘米或更短时，才被认为是阶梯切片。否则，标本被认为是非阶梯切片。比较两组间的病理分期、Gleason评分、手术切缘状况和预后。前列腺特异性抗原(PSA)复发被定义为前列腺特异性抗原(PSA)水平连续两次达到或超过0.2 ng/mL。继发性癌症治疗包括放射治疗或RP后去雄激素治疗。辅助治疗发生在RP后6个月内，非辅助治疗发生在RP后6个月以上。计算分步组和非分步组患者PSA复发和二次治疗的Kaplan-Meier事件发生率。阶梯切割组和非阶梯切割组患者在病理肿瘤分期、前列腺切除Gleason评分或切缘状况方面没有显著差异。分步切割组患者在确诊时血清PSA水平低于非分步切割组患者。在对所有患者进行检查时，根据病理分析的方法，在二次治疗的使用和PSA复发方面没有差异。然而，与非分步切除术组中的类似患者相比，接受分步切割术的切缘阴性的患者的二次非辅助治疗使用率显著降低，PSA复发的风险似乎更低。这些数据表明，对手术标本进行更完整的病理分析可能更好地预测某些接受RP手术的患者的预后。有必要进行更多的研究，以确定这种差异是否证明推荐常规步骤分段所需的额外资源是合理的。泌尿外科56：430-435,2000。(C)2000年，爱思唯尔科学公司。
Objectives. To determine whether more complete sampling of the radical prostatectomy (RP) specimen better predicts outcome after surgery.Methods. We reviewed pathology reports from 1383 patients enrolled in CaPSURE (a longitudinal registry of patients with prostate cancer) who underwent RP. Specimens were considered step-sectioned only if the entire specimen was submitted for analysis and if sections were taken at 0.5-cm intervals or less. Otherwise, specimens were considered non-step-sectioned. Pathologic stage, Gleason score, surgical margin status, and outcome were compared between groups. Prostate-specific antigen (PSA) recurrence was defined as a PSA level of 0.2 ng/mL or greater on two consecutive occasions after RP. Secondary cancer treatment consisted of radiation or androgen deprivation after RP. Adjuvant treatments occurred within 6 months of RP, and nonadjuvant treatments occurred more than 6 months after RP. Kaplan-Meier event rates of PSA recurrence and secondary treatment were calculated for patients in the step-sectioned and non-step-sectioned groups.Results. No significant differences were found between patients in the step-sectioned and non-step-sectioned groups with respect to pathologic tumor stage, prostatectomy Gleason score, or margin status. Patients in whom step-sectioning was performed had a lower serum PSA at diagnosis than patients in the non-step-sectioned group. When examining all patients, no differences were observed in the use of secondary treatments or PSA recurrence based on the method of pathologic analysis. However, patients with negative margins in whom step-sectioning was performed exhibited significantly lower secondary nonadjuvant treatment use and appeared to have a lower risk of PSA recurrence than similar patients in the non-step-sectioned group.Conclusions. These data suggest that more complete pathologic analysis of the surgical specimen may better predict outcome for some patients undergoing RP. Additional research is warranted to determine whether such differences justify the additional resources necessary to recommend routine step-sectioning. UROLOGY 56:430-435, 2000. (C) 2000, Elsevier Science Inc.