Pathological outcomes of Japanese men eligible for active surveillance after radical prostatectomy
Pathological outcomes of Japanese men eligible for active surveillance after radical prostatectomy
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DOI：
10.1007/s10147-013-0553-6
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发表时间：
2014-04
影响因子：
3.3
通讯作者：
Takahiro Inoue;H. Kinoshita;H. Inui;Yoshihiro Komai;M. Nakagawa;N. Oguchi;G. Kawa;M. Sugi;C. Ohe;Chika Miyasaka;Yorika Nakano;N. Sakaida;Y. Uemura;T. Matsuda
中科院分区：
文献类型：
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作者：
Takahiro Inoue;H. Kinoshita;H. Inui;Yoshihiro Komai;M. Nakagawa;N. Oguchi;G. Kawa;M. Sugi;C. Ohe;Chika Miyasaka;Yorika Nakano;N. Sakaida;Y. Uemura;T. Matsuda
本研究的目的是分析适合主动监测（AS）的低危前列腺癌患者的前列腺切除术标本的病理特征，并评估术前数据是否适合预测抢镜（≥pT3）或升级疾病（Gleason评分≥7），定义为“重新分类”。方法回顾性分析我院2005年1月至2011年12月521例无新辅助激素治疗的连续根治性前列腺切除术病例。84例患者符合以下标准：临床T1或T2疾病，前列腺特异性抗原（PSA）水平≤10 ng/ml，活检1或2次阳性，Gleason评分<7。比较根治性前列腺切除术后进行和未进行再分类的患者诊断时的临床病理特征。结果84例患者中40例（47.6%）Gleason评分≥7分，8例（9.5%）出现抢戏性疾病（≥pT3）。7例被抢风头的患者也表现出升级的重分类。2例重分类患者分别在术后59个月和89个月出现生化复发。术前评估的参数包括年龄、PSA水平、PSA密度（PSAD）、临床T分期、前列腺核阳性的数量和百分比。在82例数据完整的患者中，单因素分析显示PSAD （ng/ml2）是区分重分类疾病患者和非重分类疾病患者的重要参数（p< 0.001）。多因素分析显示PSAD是预测疾病重分类的唯一独立变量（p= 0.006）。结论在日本人群中，术前PSAD可作为选择AS患者的良好指标。
BackgroundThe aim of this study was to analyze the pathological features of prostatectomy specimens from patients with low-risk prostate cancer eligible for active surveillance (AS) and evaluate preoperative data suitable for predicting upstaged (≥pT3) or upgraded disease (Gleason score of ≥7), defined as ‘reclassification’.MethodsA retrospective analysis of 521 consecutive radical prostatectomy procedures (January 2005 through to December 2011) performed at our institution without neoadjuvant hormonal therapy was performed. Eighty-four patients fulfilled the following criteria—clinical T1 or T2 disease, prostate-specific antigen (PSA) level of ≤10 ng/ml, one or two positive biopsies, and Gleason score of <7. Clinicopathological features at diagnosis were compared between patients with and without reclassification after radical prostatectomy.ResultsForty of 84 patients (47.6 %) had a Gleason score of ≥7, and 8 (9.5 %) had upstaged disease (≥pT3). Seven patients with upstaged disease also showed upgraded reclassification. Two patients with reclassification showed biochemical recurrence at 59 and 89 months after surgery, respectively. Preoperative parameters evaluated included age, PSA level, PSA density (PSAD), clinical T stage, and number and percentage of positive prostate cores. Among 82 patients with complete data, univariate analysis showed that PSAD (ng/ml2) was a significant parameter to discriminate patients with reclassified disease and those without reclassified disease (p< 0.001). Multivariate analysis revealed that PSAD was the only independent variable to predict disease with reclassification (p= 0.006).ConclusionsPreoperative PSAD may be a good indicator for selecting patients eligible for AS in the Japanese population.