Inflammation and preneoplastic lesions in benign prostate as risk factors for prostate cancer
Inflammation and preneoplastic lesions in benign prostate as risk factors for prostate cancer
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DOI：
10.1038/modpathol.2012.51
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发表时间：
2012-07-01
期刊：
影响因子：
7.5
通讯作者：
Rybicki, Benjamin A.
中科院分区：
文献类型：
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作者：
Kryvenko, Oleksandr N.;Jankowski, Michelle;Rybicki, Benjamin A.
从萎缩和炎症到高级别前列腺上皮内瘤变（HGPIN）的良性变化是前列腺核心穿刺活检的常见结果。虽然萎缩和炎症可能是前列腺癌的前兆，但目前只有HGPIN被推荐纳入外科病理报告。为了确定这些良性发现是否会增加前列腺癌的风险，我们在1990年至2002年间收集了6692名前列腺良性标本的历史队列中进行了一项病例对照研究。分析样本包括574对病例对照，包括在队列进入后至少1年诊断为前列腺癌的病例，对照组与队列进入时的日期和年龄、种族和标本类型相匹配。检查最初的良性标本是否存在HGPIN、萎缩（单纯性、小叶性和部分性）和炎症（腺性和/或间质性）。HGPIN显著增加前列腺癌的风险(优势比(OR)=2.00；95%置信区间(CI)=1.25-3.20)。间质室炎症与风险降低相关（OR=0.66； CI=0.52-0.84），重度弥漫性间质炎症与风险负相关最强（OR=0.21； CI=0.07-0.62）。在队列进入和炎症时调整前列腺特异性抗原（PSA）水平的模型中，单纯萎缩与前列腺癌风险增加33%相关，差异有统计学意义（P=0.03）。临床医生在处理活检结果阴性的高危患者时应考虑炎症的模式和程度。确定高PSA水平下的良性炎症过程将有助于减少不必要的重复前列腺活检的次数。现代病理学杂志（2012）25,1023-1032；doi: 10.1038 / modpathol.2012.51;2012年3月30日在线发布
Benign changes ranging from atrophy and inflammation to high-grade prostatic intraepithelial neoplasia (HGPIN) are common findings on prostate core needle biopsies. Although atrophy and inflammation may be precursors of prostate cancer, only HGPIN is currently recommended to be included in surgical pathology reports. To determine whether these benign findings increase prostate cancer risk, we conducted a case-control study nested within a historical cohort of 6692 men with a benign prostate specimen collected between 1990 and 2002. The analytic sample included 574 case-control pairs comprised of cases diagnosed with prostate cancer a minimum of 1 year after cohort entry and controls matched to cases on date and age at cohort entry, race, and type of specimen. The initial benign specimen was reviewed for presence of HGPIN, atrophy (simple, lobular, and partial) and inflammation (glandular and/or stromal). HGPIN significantly increased risk for prostate cancer (odds ratio (OR)=2.00; 95% confidence interval (CI)=1.25-3.20). Inflammation within the stromal compartment was associated with decreased risk (OR=0.66; CI=0.52-0.84), and diffuse stromal inflammation of severe grade had the strongest inverse association with risk (OR=0.21; CI=0.07-0.62). In a model adjusted for prostate-specific antigen (PSA) level at cohort entry and inflammation, simple atrophy was associated with a 33% increased prostate cancer risk that was marginally significant (P=0.03). Clinicians should consider patterns and extent of inflammation when managing high-risk patients with negative biopsy results. Identifying benign inflammatory processes that underlie high PSA levels would help to reduce the number of unnecessary repeated prostate biopsies. Modern Pathology (2012) 25, 1023-1032; doi:10.1038/modpathol.2012.51; published online 30 March 2012