CORRELATION OF CLINICAL STAGE, SERUM PROSTATIC ACID-PHOSPHATASE AND PREOPERATIVE GLEASON GRADE WITH FINAL PATHOLOGICAL STAGE IN 275 PATIENTS WITH CLINICALLY LOCALIZED ADENOCARCINOMA OF THE PROSTATE
CORRELATION OF CLINICAL STAGE, SERUM PROSTATIC ACID-PHOSPHATASE AND PREOPERATIVE GLEASON GRADE WITH FINAL PATHOLOGICAL STAGE IN 275 PATIENTS WITH CLINICALLY LOCALIZED ADENOCARCINOMA OF THE PROSTATE
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DOI：
10.1016/s0022-5347(17)43003-5
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发表时间：
1987-07-01
影响因子：
6.6
通讯作者：
WALSH, PC
中科院分区：
文献类型：
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作者：
OESTERLING, JE;BRENDLER, CB;WALSH, PC
临床分期、血清前列腺酸性磷酸酶和术前Gleason分级在预测前列腺腺癌患者最终病理分期中的作用仍有争议。为了确定这3个术前变量的预测价值，我们回顾了1982年4月至1986年2月期间接受治疗的275例临床局限性疾病患者。所有患者术前检查，术后由1名泌尿科医生进行手术。用罗伊法测定所有患者血清前列腺酸性磷酸酶，底物为单磷酸胸腺苯酞。术前由1名病理学家确定每个前列腺活检标本的Gleason分级，该病理学家还检查了最终病理标本的包膜穿透、精囊和盆腔淋巴结受累情况。采用似然比卡方检验进行logistic回归分析，临床状态和Gleason分级与包膜穿透（p分别小于0.0001和小于0.0001）、精囊受损伤（p分别小于0.0001和小于0.0001）和淋巴结阳性（p分别小于0.0001和小于0.0002）直接相关。在正常值（0.0 ~ 0.8 IU/l）范围内，血清前列腺酸性磷酸酶与包膜穿透（p < 0.003）和精囊受累（p < 0.01）直接相关，与淋巴结受累无关（p = 0.08）。再次通过逻辑回归分析，我们确定最终病理分期的最佳预测因子不是单个变量，而是使用术前变量组合的模型。所建立的模型为：包膜穿透-血清前列腺酸性磷酸酶及Gleason分级（p < 0.00001），精囊受累-临床分期及Gleason分级（p < 0.00001），淋巴结受累-临床分期及Gleason分级（p < 0.00001）。利用这些模型构建了概率图，从而可以在术前预测临床上局限性前列腺癌患者的最终病理分期。
The usefulness of clinical stage, serum prostatic acid phosphatase and preoperative Gleason grade in predicting final pathological stage in patients with adenocarcioma of the prostate remains controversial. To determine the predictive value of these 3 preoperative variables we reviewed 275 patients with clinically localized disease who were treated between April 1982 and February 1986. All patients were examined preoperatively and subsequently were operated upon by 1 urologist. Serum prostatic acid phosphatase was determined in all patients by the Roy method using thymolphthalein monophosphate as the substrate. The Gleason grade of each prostatic biopsy specimen was determined preoperatively by 1 pathologist, who also examined the final pathological specimen with respect to capsular penetration, and seminal vesicle and pelvic lymph node involvement. Using logistic regression analysis with the likelihood ratio chi-square test, clinical state and Gleason grade had a direct correlation with capsular penetration (p less than 0.0001 and less than 0.0001, respectively), seminal vesicles involvement (p less than 0.0001 and less than 0.0001, respectively) and positive lymph nodes (p less than 0.0001 and less than 0.0002, respectively). Within the normal range of values (0.0 to 0.8 IU/l) serum prostatic acid phosphatase correlated directly with capsular penetration (p less than 0.003) and seminal vesicle involvement (p less than 0.01) but not with lymph node involvement (p equals 0.08). Again with logistic regression analysis we determined that the best predictors of final pathological stage are not individual variables but models that use combinations of preoperative variables. The models generated are as follows: capsular penetration-serum prostatic acid phosphatase and Gleason grade (p less than 0.00001), seminal vesicle involvement-clinical stage and Gleason grade (p less than 0.00001), and lymph node involvement-clinical stage and Gleason grade (p less than 0.00001). With these models probability plots have been constructed so that the final pathological stage in patients with clinically localized prostatic cancer can be predicted preoperatively.