Clinicopathologic analysis of extracapsular extension in prostate cancer: Should the clinical target volume be expanded posterolaterally to account for microscopic extension?
Clinicopathologic analysis of extracapsular extension in prostate cancer: Should the clinical target volume be expanded posterolaterally to account for microscopic extension?
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DOI：
10.1016/j.ijrobp.2006.02.039
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发表时间：
2006-07-15
影响因子：
7
通讯作者：
Kestin, Larry L.
中科院分区：
文献类型：
--
作者：
Chao, K. Kenneth;Goldstein, Neal S.;Kestin, Larry L.
目的：对371例前列腺摘除标本进行完整的病理分析，以确定是否以及何时应进行临床靶区扩容。每个病例的所有幻灯片都由一名病理学家(N.S.G.)审查。结果：共121例(33%)患者(单侧68例，双侧53例)发生了癌变。内窥镜检查平均距离2.4 mm[范围：0.05-7.0 mm]。第90个百分位距离=5.0度。在121例患者中，55%的患者屈曲距离为2 mm，19%的患者为4圈，6%的患者为6 mm。在所有病例中，Ece主要发生在神经血管束的后方。治疗前前列腺特异性抗原(PSA)、活检Gleason、病理Gleason、临床分期、双侧受累、切缘阳性、受累腺体百分比、肿瘤最大大小与ECEs的存在有关。PSA和Gleason评分均与早期教育距离相关。在所有371名患者中，对于PSA：10或活检Gleason评分=7的患者，21%的患者ECE值为2朗姆，5%的患者为包膜外4 mm。在同时存在这两种危险因素的患者中，49%的患者ECE值为2 mm，21%的患者ECE值为2：4 mm。结论：对于前列腺癌患者，ECE线性距离的中位数为2.4 mm，主要发生在后外侧。虽然只有5%的患者显示出包膜外4-5 mm，但在PSA和gt；=10 ng/ml且活检Gleason评分=7的患者中，这一风险可能超过20%。随着成像技术的改善和放射治疗交付技术的提高，对于高危患者应该考虑后外侧CTV扩张。(C)2006年爱思唯尔公司。
Purpose: We performed a complete pathologic analysis examining extracapsular extension (ECE) and microscopic spread of malignant cells beyond the prostate capsule to determine whether and when clinical target volume (CTV) expansion should be performed.Methods and Materials: A detailed pathologic analysis was performed for 371 prostatectomy specimens. All slides from each case were reviewed by a single pathologist (N.S.G.). The ECE status and ECE distance, defined as the maximal linear radial distance of malignant cells beyond the capsule, were recorded.Results: A total of 121 patients (33%) were found to have ECE (68 unilateral, 53 bilateral). Median ECE distance 2.4 mm [range: 0.05-7.0 mm]. The 90th-percentile distance = 5.0 turn. Of the 121 cases with ECE, 55% had ECE distance >= 2 mm, 19% >= 4 turn, and 6% >= 6 mm. ECE occurred primarily posterolaterally along the neurovascular bundle in all cases. Pretreatment prostrate-specific antigen (PSA), biopsy Gleason, pathologic Gleason, clinical stage, bilateral involvement, positive margins, percentage of gland involved, and maximal tumor dimension were associated with presence of ECE. Both PSA and Gleason score were associated with ECE distance. In all 371 patients, for those with either pretreatment PSA :10 or biopsy Gleason score >= 7, 21% had ECE >= 2 rum and 5% >= 4 mm beyond the capsule. For patients with both of these risk factors, 49% had ECE >= 2 mm and 21% 2:4 mm.Conclusions: For prostate cancer with ECE, the median linear distance of ECE was 2.4 mm and occurred primarily posterolaterally. Although only 5% of patients demonstrate ECE > 4 to 5 mm beyond the capsule, this risk may exceed 20% in patients with PSA >= 10 ng/ml and biopsy Gleason score >= 7. As imaging techniques improve for prostate capsule delineation and as radiotherapy delivery techniques increase in accuracy, a posterolateral CTV expansion should be considered for patients at high risk. (c) 2006 Elsevier Inc.