Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades.
Upgrading and downgrading of prostate cancer from biopsy to radical prostatectomy: incidence and predictive factors using the modified Gleason grading system and factoring in tertiary grades.
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DOI：
10.1016/j.eururo.2012.01.050
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发表时间：
2012-05
期刊：
影响因子：
23.4
通讯作者：
Pierorazio PM
中科院分区：
文献类型：
--
作者：
Epstein JI;Feng Z;Trock BJ;Pierorazio PM
先前评估穿刺活检时Gleason评分（GS）与相应根治性乳腺癌切除术（RP）相关性的研究早于改良Gleason评分系统的使用，未考虑三级模式。在迄今为止规模最大的研究中评估活检与RP分级的关系。根据更新的Gleason系统，对2004-2010年共7643例完全包埋RP和相应的针吸活检进行了分析。所有患者在RP前均接受前列腺活检。使用卡方检验、Student t检验和多变量logistic回归比较升级或降级与患者和癌症特征的关系。共有36.3%的病例从针吸活检GS 5-6升级到RP的更高级别（11.2%为GS 6+三级）。一半病例在活检和RP时具有匹配的GS 3 + 4 = 7，在RP时降级和升级的病例数量大致相等。活检GS 4 + 3 = 7，RP GS几乎相等3 + 4 = 7和4 + 3 = 7。活检GS 8导致RP GS 4 + 3 = 7、8和9-10之间几乎相等的分布。在活检和RP时，共有58%的病例具有匹配的GS 9-10。在多变量分析中，年龄增加（p < 0.0001）、血清前列腺特异性抗原水平增加（p < 0.0001）、RP体重降低（p < 0.0001）和最大癌/核心百分比增加（p < 0.0001）预测RP时活检GS从5-6升级到更高。尽管考虑了多个变量，包括阳性核心的数量和每个核心的最大癌症百分比，但一致性指数不足以证明使用列线图预测个体患者的升级和降级是合理的。几乎20%的RP病例具有三级模式。针吸活检可以在RP中采样三级更高的格里森模式，然后在标准GS报告中不记录，导致针吸活检明显分级过高。
Prior studies assessing the correlation of Gleason score (GS) at needle biopsy and corresponding radical prostatectomy (RP) predated the use of the modified Gleason scoring system and did not factor in tertiary grade patterns. To assess the relation of biopsy and RP grade in the largest study to date. A total of 7643 totally embedded RP and corresponding needle biopsies (2004–2010) were analyzed according to the updated Gleason system. All patients underwent prostate biopsy prior to RP. The relation of upgrading or downgrading to patient and cancer characteristics was compared using the chi-square test, Student t test, and multivariable logistic regression. A total of 36.3% of cases were upgraded from a needle biopsy GS 5–6 to a higher grade at RP (11.2% with GS 6 plus tertiary). Half of the cases had matching GS 3 + 4 = 7 at biopsy and RP with an approximately equal number of cases downgraded and upgraded at RP. With biopsy GS 4 + 3 = 7, RP GS was almost equally 3 + 4 = 7 and 4 + 3 = 7. Biopsy GS 8 led to an almost equal distribution between RP GS 4 + 3 = 7, 8, and 9–10. A total of 58% of the cases had matching GS 9–10 at biopsy and RP. In multivariable analysis, increasing age (p < 0.0001), increasing serum prostate-specific antigen level (p < 0.0001), decreasing RP weight (p < 0.0001), and increasing maximum percentage cancer/core (p < 0.0001) predicted the upgrade from biopsy GS 5–6 to higher at RP. Despite factoring in multiple variables including the number of positive cores and the maximum percentage of cancer per core, the concordance indexes were not sufficiently high to justify the use of nomograms for predicting upgrading and downgrading for the individual patient. Almost 20% of RP cases have tertiary patterns. A needle biopsy can sample a tertiary higher Gleason pattern in the RP, which is then not recorded in the standard GS reporting, resulting in an apparent overgrading on the needle biopsy.