Prognostic factors and reporting of prostate carcinoma in radical prostatectomy and pelvic lymphadenectomy specimens
Prognostic factors and reporting of prostate carcinoma in radical prostatectomy and pelvic lymphadenectomy specimens
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DOI：
10.1080/03008880510030932
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发表时间：
2005-05-01
影响因子：
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通讯作者：
Montironi, R
中科院分区：
文献类型：
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作者：
Epstein, JI;Amin, M;Montironi, R
本文以2004年世界卫生组织主办的国际会诊中基于形态的预后因素委员会的活动为基础，描述了处理前列腺癌根治术标本的各种方法，以供临床和研究之用。详细讨论了前列腺癌根治术结果与术后失败的关系。这包括与盆腔淋巴结受累有关的问题，在冰冻切片和永久切片中都能检测到。对精囊侵袭的定义、侵袭途径和与预后的关系等问题进行了详细的讨论。阐述了前列腺外扩张的定义、术语和发生率，以及与位置和范围有关的预后意义。切缘的范围包括切缘的定义、病因、切缘阳性的发生率和部位、使用冰冻切片评估切缘以及切缘阳性与预后之间的关系。与前列腺癌根治术标本中的分级有关的问题被深入讨论，包括报告格里森分级的新方法和第三格里森模式的概念。肿瘤体积、肿瘤部位、血管侵犯和神经周围。侵袭性是与前列腺癌根治术标本预后相关的最终变量。讨论了使用多变量分析来预测进展，以及对TNM系统的拟议修改。最后介绍了预测前列腺癌根治术后进展的生物标志物，包括DNA倍体、微血管密度、Ki-67、神经内分泌分化、P53、p21、p27、Bcl2、HER-2/neu、E-cadherin、CD44、视网膜母细胞瘤蛋白、细胞凋亡指数、雄激素受体状态、前列腺特异性抗原和前列腺特异性酸性磷酸酶的表达以及核形态计量学。
This paper, based on the activity of the Morphology-Based Prognostic Factors Committee of the 2004 World Health Organization-sponsored International Consultation, describes various methods of handling radical prostatectomy specimens for both routine clinical use and research purposes. The correlation between radical prostatectomy findings and postoperative failure is discussed in detail. This includes issues relating to pelvic lymph node involvement, detected both at the time of frozen section and in permanent sections. Issues of seminal vesicle invasion, including its definition, routes of invasion and relationship to prognosis, are covered in detail. The definition, terminology and incidence of extra-prostatic extension are elucidated, along with its prognostic significance relating to location and extent. Margins of resection are covered in terms of their definition, the etiology, incidence and sites of positive margins, the use of frozen sections to assess the margins and the relationship between margin positivity and prognosis. Issues relating to grade within the radical prostatectomy specimen are covered in depth, including novel ways of reporting Gleason grade and the concept of tertiary Gleason patterns. Tumor volume, tumor location, vascular invasion and perineural. invasion are the final variables discussed relating to the prognosis of radical prostatectomy specimens. The use of multivariate analysis to predict progression is discussed, together with proposed modifications to the TNM system. Finally, biomarkers to predict progression following radical prostatectomy are described, including DNA ploidy, microvessel density, Ki-67, neuroendocrine differentiation, p53, p21, p27, Bcl-2, Her-2/neu, E-cadherin, CD44, retinoblastoma proteins, apoptotic index, androgen receptor status, expression of prostate-specific antigen and prostatic-specific acid phosphatase and nuclear morphometry.