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首页> 外文期刊>BMC Urology >Pathological upgrading in prostate cancer treated with surgery in the United Kingdom: trends and risk factors from the British Association of Urological Surgeons Radical Prostatectomy Registry
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Pathological upgrading in prostate cancer treated with surgery in the United Kingdom: trends and risk factors from the British Association of Urological Surgeons Radical Prostatectomy Registry

机译：英国通过手术治疗的前列腺癌的病理升级：来自英国泌尿外科外科医生根治性前列腺切除术注册中心的趋势和危险因素

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Accurate grading at the time of diagnosis if fundamental to risk stratification and treatment decision making in patients with prostate cancer. Whilst previous studies have demonstrated significant pathological upgrading and downgrading following radical prostatectomy (RP), these were based on historical cohorts and do not reflect contemporary patient selection and management practices. The aim of this national, multicentre observational study was to characterise contemporary rates and risk factors for pathological upgrading after RP in the United Kingdom (UK). All RP entries on the British Association of Urological Surgeons (BAUS) Radical Prostatectomy Registry database of prospectively entered cases undertaken between January 2011 and December 2016 were extracted. Those patients with full preoperative PSA, clinical stage, needle biopsy and subsequent RP pathological grade information were included. Upgrade was defined as any increase in Gleason grade from initial needle biopsy to pathological assessment of the entire surgical specimen. Statistical analysis and multivariate logistic regression were undertaken using R version 3.5 (R Foundation for Statistical Computing, Vienna, Austria). A total of 17,598 patients met full inclusion criteria. Absolute concordance between initial biopsy and pathological grade was 58.9% (n = 10,364), whilst upgrade and downgrade rates were 25.5% (n = 4489) and 15.6% (n = 2745) respectively. Upgrade rate was highest in those with D’Amico low risk compared with intermediate and high-risk disease (55.7% versus 19.1 and 24.3% respectively, P 0.001). Although rates varied between year of surgery and geographical regions, these differences were not significant after adjusting for other preoperative diagnostic variables using multivariate logistic regression. Pathological upgrading after RP in the UK is lower than expected when compared with other large contemporary series, despite operating on a generally higher risk patient cohort. As new diagnostic techniques that may reduce rates of pathological upgrading become more widely utilised, this study provides an important benchmark against which to measure future performance.
机译：如果对前列腺癌患者的风险分层和治疗决策至关重要，则在诊断时进行准确的分级。尽管先前的研究表明根治性前列腺切除术（RP）后病理显着升级和降级，但这些都是基于历史队列，并不反映当代患者的选择和管理实践。这项全国性，多中心的观察性研究的目的是表征英国（UK）进行RP后的当代比率和病理升级的危险因素。提取了2011年1月至2016年12月间进行的预期输入病例的英国泌尿外科外科医生协会（BAUS）根治性前列腺切除术注册数据库中所有RP条目。包括那些具有完整的术前PSA，临床分期，穿刺活检以及随后的RP病理分级信息的患者。升级定义为从最初的穿刺活检到整个手术标本的病理评估，格里森评分的任何升高。使用R版本3.5（R统计学计算基金会，维也纳，奥地利）进行统计分析和多元逻辑回归。共有17,598名患者符合完全纳入标准。初始活检与病理分级之间的绝对一致性为58.9％（n = 10,364），而升级和降级的比率分别为25.5％（n = 4489）和15.6％（n = 2745）。与中度和高危疾病相比，D'Amico低危人群的升级率最高（分别为55.7％，19.1和24.3％，P <0.001）。尽管手术年份和地理区域之间的比率有所不同，但在使用多元逻辑回归对其他术前诊断变量进行调整后，这些差异并不明显。尽管在较高风险的患者队列中进行手术，但与其他大型当代医学期刊相比，英国RP后的病理学升级低于预期。随着可以降低病理升级率的新诊断技术得到越来越广泛的应用，本研究提供了衡量未来表现的重要基准。

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