Should Intervening Benign Tissue Be Included in the Measurement of Discontinuous Foci of Cancer on Prostate Needle Biopsy? Correlation With Radical Prostatectomy Findings
Should Intervening Benign Tissue Be Included in the Measurement of Discontinuous Foci of Cancer on Prostate Needle Biopsy? Correlation With Radical Prostatectomy Findings
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DOI：
10.1097/pas.0b013e3182217b79
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发表时间：
2011-09-01
影响因子：
5.6
通讯作者：
Epstein, Jonathan I.
中科院分区：
文献类型：
--
作者：
Karram, Sarah;Trock, Bruce J.;Epstein, Jonathan I.
目前，当单个核心中存在2个或更多个前列腺癌病灶被良性间质隔开时，对于测量肿瘤长度或核心上癌症百分比的最佳方法没有共识。一种选择是测量不连续的癌症病灶，就像它们是一个单一的连续病灶一样。另一种选择是增加单个单独癌症病灶的测量值，忽略介入良性前列腺组织的范围。在约翰霍普金斯医院的外科病理学数据库中检索了2005年至2010年患者来我院进行根治性前列腺切除术（RP）时审查的前列腺穿刺活检的外部咨询病例。病例仅限于活检Gleason评分6的病例，其中外部和我们机构之间在报告的每个病例每个核心的最高癌症百分比方面至少有15%的不一致性。109例患者符合我们的入选标准。79例患者在RP中显示了相同的格里森评分，30例患者的格里森评分升级至>= 7。包括所有病例（RP评分为6、7和8），每个核心的最大癌症百分比与器官局限性疾病或手术切缘阳性风险之间没有显著相关性，无论核心是在霍普金斯还是在外部机构测量。对于RP未升级的病例，霍普金斯和外部机构记录的每个病例每个核心的最大癌症百分比之间的差异范围为15%至80%，其中平均值和中位数差异分别为35%和30%。与外部机构给出的百分比（P = 0.027）相比，我们机构给出的每个核心病例的肿瘤累及最大百分比与器官局限性疾病的存在更密切相关（P = 0.004）。手术切缘阳性也与我们研究机构给出的每个核心的肿瘤累及的最大百分比相关（P = 0.004），而外部百分比不是切缘状态的显著预测因子（P = 0.2）。在多变量分析中，在霍普金斯测量的每个病例每个核心的最大癌症百分比（包括测量中的介入良性前列腺组织）也比忽略介入良性组织更能预测分期和边缘。总之，我们的研究表明，对于其中针吸活检分级代表整个肿瘤的前列腺癌，通过从一端到另一端测量活检上的不连续癌症来量化活检上的癌症范围，而不是通过减去介入的良性前列腺组织来“塌陷”癌症，这与器官局限性疾病和阳性边缘的风险更相关。
Currently, there is no consensus as to the optimal method for measuring tumor length or percentage of cancer on a core when there are 2 or more foci of prostate cancer in a single core separated by benign intervening stroma. One option is to measure discontinuous foci of cancer as if they were 1 single continuous focus. The other option is to add the measurements of the individual separate foci of cancer, ignoring the extent of the intervening benign prostate tissue. The surgical pathology database at The Johns Hopkins Hospital was searched for outside consult cases of prostate needle biopsies reviewed between 2005 and 2010 when the patient came to our institution for radical prostatectomy (RP). Cases were restricted to those with biopsy Gleason score 6 in which there was at least 15% discordance between the outside and our institution in terms of the reported highest percentage of cancer per core per case. One hundred and nine patients were identified fulfiling our inclusion criteria. Seventy-nine showed the same Gleason score in the RP, and 30 had an upgrade to Gleason >= 7. Including all cases (scores 6, 7, and 8 at RP), there was no significant association between the maximum percentage of cancer per core with organ-confined disease or risk of positive surgical margins, regardless if the cores were measured at Hopkins or at the outside institutions. For cases with no upgrade at RP, the differences between the maximum percentage of cancer per core per case recorded at Hopkins and the outside institutions ranged from 15% to 80%, in which the mean and median differences were 35% and 30%, respectively. The maximum percentages of tumor involvement on a core per case given at our institution more strongly correlated with the presence of organ-confined disease (P = 0.004) compared with the percentages given at the outside institutions (P = 0.027). Surgical margin positivity was also associated with the maximum percentages of tumor involvement per core given at our institution (P = 0.004), whereas the outside percentages were not significant predictors of margin status (P = 0.2). In a multivariable analysis, maximum percentage of cancer per core per case measured at Hopkins which includes intervening benign prostate tissue in the measurement was also more predictive of stage and margins than ignoring intervening benign tissue. In summary, our study demonstrated that for prostate cancer in which the needle biopsy grade is representative of the entire tumor, quantifying cancer extent on biopsy by measuring discontinuous cancer on biopsy from one end to the other as opposed to "collapsing" the cancer by subtracting out the intervening benign prostate tissue correlates better with organ-confined disease and risk of positive margins.