CAN AGGRESSIVE PROSTATIC CARCINOMAS BE IDENTIFIED AND CAN THEIR NATURAL-HISTORY BE ALTERED BY TREATMENT
CAN AGGRESSIVE PROSTATIC CARCINOMAS BE IDENTIFIED AND CAN THEIR NATURAL-HISTORY BE ALTERED BY TREATMENT
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DOI：
10.1016/s0090-4295(99)80254-4
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发表时间：
1995-09-01
期刊：
影响因子：
2.1
通讯作者：
WALSH, PC
中科院分区：
文献类型：
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作者：
QUINLAN, DM;PARTIN, AW;WALSH, PC
决定肿瘤侵袭性的因素是多因素的：年龄、分期和分级。由于遗传漂变和肿瘤异质性，即使是年轻患者中分化良好的肿瘤也可能在某一天具有侵袭性。在最近对826例经保守治疗的有利选择病例的审查中，10年时，19%的I级肿瘤发生转移性疾病，42%的II级肿瘤发生转移性疾病，74%的III级肿瘤发生转移性疾病。认识到< 20%的男性患有I级疾病，大多数前列腺癌对寿命超过10年的男性的生命构成威胁。另一方面，一些肿瘤在介绍太远先进的治愈。为了提高术前分期的准确性，我们根据临床分期、分级和血清前列腺特异性抗原（PSA）制定了列线图。传统上，高级别肿瘤（Gleason 8-10）的患者从未被认为是根治性直肠癌切除术的候选人，因为他们对长期生存的期望很低。然而，随着前列腺癌分期的改善和根治性前列腺切除术发病率的降低，这些患者中的一部分是治愈性治疗的潜在候选者。我们最近研究了72例针吸活检Gleason评分为8-10的临床局限性疾病患者的临床结局（9例T1 c，22例T2 a，17例T2 b，13例T2 c和11例T3 a）。在63名接受根治性直肠癌切除术的男性中，46名（68%）淋巴结阴性; 9名因冷冻切片发现淋巴结阳性而未接受手术。淋巴结阴性男性5年时血清PSA检测不到的精算可能性为43%，器官局限性疾病男性为45%。因此，通过适当的评估，即使是最具侵袭性的肿瘤，如果盆腔淋巴结阴性，也可以通过手术治愈。
The factors that determine tumor aggressiveness are multifactorial: age, stage, and grade. Even a well differentiated tumor in a young patient may be aggressive someday because of genetic drift and tumor heterogeneity. In a recent review of 826 favorably selected cases managed with conservative therapy, metastatic disease had developed in 19% with grade I tumors, 42% with grade II, and 74% with grade III at 10 years. Recognizing that < 20% of men present with grade I disease, most prostate cancers are a threat to life in men who are going to live longer than 10 years. On the other hand, some tumors at presentation are too far advanced to cure. To improve the accuracy of preoperative staging in identifying these cases, we have developed nomograms based upon clinical stage, grade, and serum prostate-specific antigen (PSA). Traditionally, patients with high-grade tumors (Gleason 8-10) were never considered candidates for radical prostatectomy because of their poor expectancy for long-term survival. However, with improvements in the staging of prostate cancer and with a reduction in the morbidity of radical prostatectomy, a subset of these patients are potential candidates for curative therapy. We have recently studied the clinical outcome of 72 men with Gleason scores of 8-10 on needle biopsies who presented with clinically localized disease (9 T1c, 22 T2a, 17 T2b, 13 T2c, and 11 T3a). Of the 63 men who underwent radical prostatectomy, 46(68%) had negative lymph nodes; nine did not undergo surgery because of positive lymph nodes identified from frozen section. The actuarial likelihood of an undetect able serum PSA at 5 years was 43% for men with negative lymph nodes and 45% for men with organ-confined disease. Thus, with proper evaluation, some men with even the most aggressive tumors can be cured by surgery if their pelvic lymph nodes are negative.