Transition zone carcinoma of the prostate gland: a common indolent tumour type that occasionally manifests aggressive behaviour
Transition zone carcinoma of the prostate gland: a common indolent tumour type that occasionally manifests aggressive behaviour
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DOI：
10.1080/00313020310001619154
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发表时间：
2003-12-01
期刊：
影响因子：
4.5
通讯作者：
Cohen, RJ
中科院分区：
文献类型：
--
作者：
Shannon, BA;McNeal, JE;Cohen, RJ
目的：发生在前列腺移行区（TZ）的肿瘤通常分化良好，临床上被认为不重要。我们已经观察到的例子，高级别TZ癌症，促使本study.Methods：审查654根治性直肠癌切除术标本以前评估的系统性全器官组织学确定了187（29%）TZ癌症，其中76（11.6%）代表的指数（主要）肿瘤。这些进行了比较与体积匹配组的76个周边区（PZ）carcinoma.Results：五十九个76 TZ指数癌有额外的小肿瘤主要位于PZ。与大小相似的PZ肿瘤相比，TZ肿瘤的Gleason评分明显较低，Gleason 4/5级较少，包膜穿透率和手术切缘阳性率较低。然而，在该TZ肿瘤组中，7例癌主要为Gleason 4级或5级，包膜穿透率高（57%），手术切缘阳性（43%）。阳性前和膀胱颈边缘TZ癌比外周肿瘤和经会阴活检是TZ癌diagnosis.Conclusions的方法的选择：一个子集的TZ癌的特点是高肿瘤分级有一个显着的前列腺外扩散，边缘阳性和可能的生化失败的风险。我们建议经会阴前列腺活检用于TZ肿瘤诊断，并在根治性前列腺切除术中对前TZ进行组织学取样，即使肉眼正常，以检测有侵袭性TZ癌风险的患者。
Aims: Tumours arising in the transition zone (TZ) of the prostate gland are often well differentiated and considered clinically unimportant. We have observed examples of high-grade TZ cancers that prompted this study.Methods: Review of 654 radical prostatectomy specimens previously assessed by systematic whole organ histology identified 187 (29%) TZ cancers of which 76 (11.6%) represented the index (main) tumour. These were compared with a volume-matched group of 76 peripheral zone (PZ) carcinomas.Results: Fifty-nine of 76 TZ index carcinomas had additional minor tumours mainly located in the PZ. Compared to PZ tumours of similar size, TZ tumours had significantly lower Gleason scores, less Gleason grade 4/5 and lower rates of capsular penetration and positive surgical margins. However, within this TZ tumour group, seven carcinomas had a major Gleason grade 4 or 5 component with high rates of capsular penetration (57%) and positive surgical margins (43%). Positive anterior and bladder neck margins were more common in TZ carcinoma than peripheral tumours and transperineal biopsy was the method of choice for TZ cancer diagnosis.Conclusions: A subset of TZ carcinoma characterised by high tumour grade has a significant risk of extraprostatic spread, margin positivity and possible biochemical failure. We recommend transperineal prostate biopsy for TZ tumour diagnosis and histological sampling of the anterior TZ at radical prostatectomy, even if macroscopically normal, to detect patients at risk from aggressive TZ carcinoma.