Unfavorable Intermediate-Risk Prostate Cancer and the Odds of Upgrading to Gleason 8 or Higher at Prostatectomy
Unfavorable Intermediate-Risk Prostate Cancer and the Odds of Upgrading to Gleason 8 or Higher at Prostatectomy
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DOI：
10.1016/j.clgc.2016.06.001
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发表时间：
2017-04-01
影响因子：
3.2
通讯作者：
D'Amico, Anthony V.
中科院分区：
文献类型：
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作者：
Martin, Neil E.;Chen, Ming-Hui;D'Amico, Anthony V.
为了决定是否对患有不利的中危前列腺癌的男性实施放射治疗和短程或长程雄激素剥夺治疗，当前列腺特异性抗原低(5 ng/mL)和核心长度百分比高(70%)时，可以考虑多参数磁共振成像来识别隐匿性Gleason评分8分或更高的疾病。背景：一些患有不利的中危前列腺癌(PC)的男性有Gleason评分为8分或更高的隐匿性疾病，因为抽样误差会将治疗从短程雄激素剥夺治疗转变为长疗程结合放射治疗。确定这样的人可能会改善结果。患者和方法：研究队列包括在2005-2008年间接受根治性前列腺切除术(RP)的136名中危前列腺癌患者。我们进行了Logistic回归分析，以确定与RP时Gleason评分升至8或更高相关的临床因素。结果：14%的男性在RP时Gleason评分达到8分或更高。前列腺特异性抗原(PSA)(调整后的优势比，1.98；95%可信区间，1.19，3.30；P=.01)和最大百分比核心长度(GPC)(调整后的优势比，1.11；95%可信区间，1.03，1.19；P<；.01)的增加都与升级显著相关。PSA和GPC之间存在显著的交互作用(P=0.01)。具体地说，与PSA和GPC低于70%或更低的男性(35%比0%；P=.01)相比，PSA低(5 ng/毫升)和GPC较大(>；70%)的男性在RP的Gleason评分为8或更高的可能性显著更高(35%比0%；P=.01)，而PSA水平和GPC；5 ng/毫升的男性则不是这样(16%比9%；P=.36)。结论：在中危PC患者中，当PSA低，核心长百分比高时，可考虑进行多参数磁共振成像，以确定隐匿性Gleason评分8分或更高的疾病，并将治疗从短疗程雄激素剥夺治疗改为长疗程雄激素去除治疗和放射治疗。(C)2016 Elsevier Inc.保留所有权利。
In order to decide whether to administer radiation and a short or long course of androgen deprivation therapy in men with unfavorable intermediate-risk prostate cancer, multiparametric magnetic resonance imaging could be considered when the prostate-specific antigen is low (< 5 ng/mL) and the percentage core length high (> 70%) to identify occult Gleason score 8 or higher disease.Background: Some men with unfavorable intermediate-risk prostate cancer (PC) have occult disease with a Gleason score of 8 or higher unrecognized on biopsy because of a sampling error that would change management to long from short course androgen-deprivation therapy in conjunction with radiotherapy. Identifying such men could improve outcomes. Patients and Methods: The study cohort consisted of 136 consecutive men with unfavorable intermediate-risk PC who underwent radical prostatectomy (RP) between 2005 and 2008. We performed logistic regression analysis to identify clinical factors associated with upgrading to a Gleason score of 8 or higher at RP. Results: Fourteen percent of the men were upgraded to a Gleason score of 8 or higher PC at RP. Both increasing prostate-specific antigen (PSA) (adjusted odds ratio, 1.98; 95% confidence interval, 1.19, 3.30; P = .01) and greatest percentage core length (GPC) (adjusted odds ratio, 1.11; 95% confidence interval, 1.03, 1.19; P < .01) were significantly associated with upgrading. A significant interaction between PSA and GPC was observed (P = .01). Specifically, men with low PSA (< 5 ng/mL) and those with larger GPC (> 70%) were significantly more likely to have a Gleason score of 8 or higher at RP compared to men with low PSA and GPC of 70% or less (35% vs. 0%; P = .01), whereas the same was not true among men with PSA levels > 5 ng/mL (16% vs. 9%; P = .36). Conclusion: In men with unfavorable intermediate-risk PC, a multiparametric magnetic resonance imaging could be considered when the PSA is low and the percentage core length high to identify occult Gleason score 8 or higher disease and change management from short to long course androgen-deprivation therapy and radiotherapy. (C) 2016 Elsevier Inc. All rights reserved.