Inflammation, focal atrophic lesions, and prostatic intraepithelial neoplasia with respect to risk of lethal prostate cancer.
Inflammation, focal atrophic lesions, and prostatic intraepithelial neoplasia with respect to risk of lethal prostate cancer.
复制标题
DOI：
10.1158/1055-9965.epi-11-0373
复制
发表时间：
2011-10
期刊：
影响因子：
--
通讯作者：
Rider JR
中科院分区：
文献类型：
--
作者：
Davidsson S;Fiorentino M;Andrén O;Fang F;Mucci LA;Varenhorst E;Fall K;Rider JR
前列腺癌（PCa）管理的一个挑战是在诊断时识别潜在的致命疾病。炎症、局灶性前列腺萎缩和前列腺上皮内瘤变（PIN）在前列腺肿瘤标本中很常见，但尚不清楚这些病变是否具有预后意义。我们在瑞典通过经尿道前列腺切除术诊断为T1 a-b期PCa的男性队列中进行了一项病例对照研究。病例为死于PCa的男性（n=228）。对照组是在PCa诊断后存活超过10年且无转移的男性（n=387）。评估载玻片的Gleason分级、炎症、PIN和局灶性前列腺萎缩的四种亚型：单纯萎缩（SA）、萎缩后增生（PAH）、单纯萎缩伴囊肿形成和部分萎缩。我们用多变量logistic回归估计了致死性PCa的比值比（OR）和95%置信区间（CI）。慢性炎症和PIN在PAH肿瘤中更常见，但在SA中则不然。没有特定类型的萎缩或炎症与致死性PCa总体显著相关，但提示慢性炎症呈正相关。与年龄、Gleason评分、诊断年份、炎症和萎缩类型无关，PIN患者死于PCa的可能性高89%（95%CI：1.04-3.42）。我们的数据表明，PIN，可能存在中度或重度慢性炎症，可能有预后意义的前列腺癌。肿瘤邻近组织的病变，而不仅仅是肿瘤本身，可能有助于识别临床相关疾病。
A challenge in prostate cancer (PCa) management is identifying potentially lethal disease at diagnosis. Inflammation, focal prostatic atrophy and prostatic intraepithelial neoplasia (PIN) are common in prostate tumor specimens, but it is not clear whether these lesions have prognostic significance. We conducted a case-control study nested in a cohort of men diagnosed with stage T1a-b PCa through transurethral resection of the prostate in Sweden. Cases are men who died of PCa (n=228). Controls are men who survived more than 10 years after PCa diagnosis without metastases (n=387). Slides were assessed for Gleason grade, inflammation, PIN, and four subtypes of focal prostatic atrophy: simple atrophy (SA), post-atrophic hyperplasia (PAH), simple atrophy with cyst formation, and partial atrophy. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) for odds of lethal PCa with multivariable logistic regression. Chronic inflammation and PIN were more frequently observed in tumors with PAH, but not SA. No specific type of atrophy or inflammation was significantly associated with lethal PCa overall, but there was a suggestion of a positive association for chronic inflammation. Independent of age, Gleason score, year of diagnosis, inflammation, and atrophy type, men with PIN were 89% more likely to die of PCa (95% CI:1.04-3.42). Our data demonstrate that PIN, and perhaps presence of moderate or severe chronic inflammation, may have prognostic significance for PCa. Lesions in tumor adjacent tissue, and not just the tumor itself, may aid in identification of clinically relevant disease.