Prognostic significance of gleason pattern in patients with gleason score 7 prostate carcinoma
Prognostic significance of gleason pattern in patients with gleason score 7 prostate carcinoma
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DOI：
10.1002/cncr.11850
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发表时间：
2003-12-15
期刊：
影响因子：
6.2
通讯作者：
Henshall, SM
中科院分区：
文献类型：
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作者：
Rasiah, KK;Stricker, PD;Henshall, SM
背景。在目前的研究中，作者试图进一步对Gleason评分（GS） 7的前列腺癌患者的预后进行分层。他们评估了主要的低分化Gleason模式（原发性Gleason模式[GP] 4）和/或高级别低分化肿瘤的小病灶（三级gp5）对预后的影响。作者研究了1989年11月至2002年12月在澳大利亚某医院接受根治性前列腺切除术的412例GS - 7肿瘤患者（平均术后随访33个月）。采用卡方检验、Kaplan-Meier法和Cox比例风险分析评价原发性GP 4和三级GP 5与不良病理特征的发生和疾病复发的相关性。在该队列中，307例（75%）患者为原发性GP 3肿瘤，103例（25%）患者为原发性GP 4肿瘤，17例（2.3%）患者为三级高级别肿瘤（GP 5）。原发性GP 4肿瘤患者表现出更高的精囊受累和前列腺外展率，并且与第三期GP 5肿瘤患者一起，疾病复发时间明显缩短。单因素分析表明，原发性GP 4 （P = 0.0003）和三级GP 5 （P < 0.0001）是疾病复发的强预测因子。逐步多因素分析显示，原发性GP 4 （P = 0.0122）仍然是疾病复发的独立预测因子。原发性gp4肿瘤是gp7前列腺癌的侵袭性亚群。原发性GP是gs7前列腺癌患者疾病复发的一个容易获得且具有临床相关性的预测因子。(C) 2003年美国癌症协会。
BACKGROUND. in the current study, the authors sought to further stratify the prognosis of patients with Gleason score (GS) 7 prostate carcinoma. They assessed the influence on outcome of a predominant poorly differentiated Gleason pattern (primary Gleason pattern [GP] 4) and/or a coincident small focus of poorly differentiated tumor of higher grade (tertiary GP 5).METHODS. The authors studied 412 patients (mean postoperative follow-up, 33 months) with GS 7 tumors treated with radical prostatectomy at a single Australian campus between November 1989 and December 2002. The chi-square test, Kaplan-Meier method, and Cox proportional hazards analyses were used to evaluate the correlation between primary GP 4 and tertiary GP 5 with the occurrence of adverse pathologic features and disease recurrence.RESULTS. in this cohort, 307 patients (75%) had primary GP 3 tumors, 103 (25%) had primary GP 4 tumors, and 17 (2.3%) had a tertiary element of high-grade tumor (GP 5). Patients with primary GP 4 tumors displayed higher rates of seminal vesicle involvement and extraprostatic extension and, along with patients with tertiary GP 5, had significantly shorter times to disease recurrence. Univariate analysis demonstrated that primary GP 4 (P = 0.0003) and tertiary GP 5 (P < 0.0001) were strong predictors of disease recurrence. Primary GP 4 (P = 0.0122) remained an independent predictor of disease recurrence on stepwise multivariate analysis.CONCLUSIONS. Primary GP 4 tumors represented an aggressive subset of GS 7 prostate carcinomas. Primary GP was an easily accessible and clinically relevant predictor of disease recurrence in patients with GS 7 prostate carcinoma. (C) 2003 American Cancer Society.