PROSTATIC INTRAEPITHELIAL NEOPLASIA IS A RISK FACTOR FOR ADENOCARCINOMA - PREDICTIVE ACCURACY IN NEEDLE BIOPSIES
PROSTATIC INTRAEPITHELIAL NEOPLASIA IS A RISK FACTOR FOR ADENOCARCINOMA - PREDICTIVE ACCURACY IN NEEDLE BIOPSIES
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DOI：
10.1016/s0022-5347(01)66840-x
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发表时间：
1995-10-01
影响因子：
6.6
通讯作者：
STILMANT, M
中科院分区：
文献类型：
--
作者：
DAVIDSON, D;BOSTWICK, DG;STILMANT, M
目的：高级别前列腺上皮内瘤变被认为是前列腺腺癌最可能的前兆。然而，前列腺上皮内瘤变的自然历史和对癌症的预测价值尚不清楚。材料与方法：为了研究高级别前列腺上皮内瘤变的预测价值，我们对100例高级别前列腺上皮内瘤变患者和112例未患前列腺上皮内瘤变的患者进行回顾性临床对比研究，其针活检结果与直肠指检结果、患者年龄和血清前列腺特异性抗原水平相匹配。仅包括1次或1次以上随访活检的患者。结果：在前列腺上皮内瘤变患者的后续活检中，腺癌被确定为35%，而对照组活检的这一比例为13%。发现癌症的可能性随着初次活检间隔的增加而增加。高级别前列腺上皮内瘤变、患者年龄和血清前列腺特异性抗原浓度是癌症的高度显著预测因子，其中前列腺上皮内瘤变的风险比最高，为14.93（95%可信区间为5.6 ~ 39.8）。没有其他候选预测因子是显著的，包括直肠指检结果、经直肠超声结果、活检中前列腺上皮内瘤变的数量和前列腺上皮内瘤变的建筑模式。结论：这些结果表明，针活检中出现的高级别前列腺上皮内瘤变是癌症的有力预测指标。前列腺上皮内瘤变应在针活检和重复活检中报告。这些发现支持了前列腺上皮内瘤变是前列腺癌前兆的假设。
Purpose: High grade prostatic intraepithelial neoplasia is considered the most likely precursor of prostatic adenocarcinoma. However, the natural history and predictive value of prostatic intraepithelial neoplasia for cancer are unknown.Materials and Methods: To examine the predictive value of high grade prostatic intraepithelial neoplasia, we conducted a retrospective clinic based comparative study of 100 patients with high grade prostatic intraepithelial neoplasia and 112 without prostatic intraepithelial neoplasia on needle biopsies matched for digital rectal examination findings, patient age and serum prostate specific antigen level. Only patients who had 1 or more followup biopsies were included.Results: Adenocarcinoma was identified in 35% of subsequent biopsies from patients with prostatic intraepithelial neoplasia, compared with 13% of control biopsies. The likelihood of finding cancer increased as the interval from initial biopsy increased. High grade prostatic intraepithelial neoplasia, patient age and serum prostate specific antigen concentration were jointly highly significant predictors of cancer, with prostatic intraepithelial neoplasia providing the highest risk ratio of 14.93 (95% confidence intervals 5.6 to 39.8). No other candidate predictor was significant, including digital rectal examination findings, transrectal ultrasound results, amount of prostatic intraepithelial neoplasia on biopsy and architectural pattern of prostatic intraepithelial neoplasia.Conclusions: These results indicate that the presence of high grade prostatic intraepithelial neoplasia on needle biopsy is strongly predictive of carcinoma. Prostatic intraepithelial neoplasia should be reported in needle biopsies and biopsy repeated. These findings support the hypothesis that prostatic intraepithelial neoplasia is a precursor of prostate cancer.