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首页> 外文期刊>Urologic oncology >Patient risk stratification using Gleason score concordance and upgrading among men with prostate biopsy Gleason score 6 or 7.
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Patient risk stratification using Gleason score concordance and upgrading among men with prostate biopsy Gleason score 6 or 7.

机译：使用Gleason评分一致性进行患者风险分层，并在前列腺活检Gleason评分为6或7的患者中进行升级。

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PURPOSE: To define the impact of discordant Gleason sum (GS) between prostate biopsy (Pbx) tissue and radical prostatectomy (RP) specimen among men initially diagnosed with Gleason 6 or 7 prostate adenocarcinoma. MATERIALS AND METHODS: We evaluated patients diagnosed with GS 6 or 7 and treated primarily with RP. We defined the frequency of GS discordance between Pbx and RP pathology reports. We analyzed pretreatment parameters associated with GS discordance and compared immediate postprostatectomy outcome variables across patient groups defined by their GS and concordance. We then conducted survival analysis for biochemical recurrence across patient groups defined by their GS and concordance status. RESULTS: Among patients with GS 6 on Pbx, 681/1,847 (36.86%) patients were upgraded to GS 7 or higher after RP. Surgical margin, capsular involvement, seminal vesicle, and nodal involvement status were more favorable in patients with concordant Pbx and RP specimen with GS 6 (P < 0.0001). Patients with smaller transrectal ultrasound (TRUS) prostate volume were found to have higher PSA densities and were more likely to be upgraded at RP. Multivariate survival analysis also predicted fewer biochemical recurrence events over time in men with concordant Pbx tissue and RP specimen of GS 6 vs. 6/7 or 7/7 (P = 0.0025) controlling for other relevant covariates. CONCLUSIONS: GS discordance between Pbx tissue and RP specimens among prostate cancer patients initially diagnosed with either GS 6 or 7 adenocarcinoma of the prostate is substantial. This discordance has potential clinical significance in predicting oncologic outcomes.
机译：目的：确定在最初被诊断为格里森6或7型前列腺腺癌的男性中，前列腺活检（Pbx）组织和根治性前列腺切除术（RP）标本之间不一致的格里森和（GS）的影响。材料与方法：我们评估了诊断为GS 6或7且主要接受RP治疗的患者。我们定义了Pbx和RP病理报告之间GS不一致的频率。我们分析了与GS不一致性相关的预处理参数，并比较了由其GS和一致性定义的患者组中前列腺切除术后即刻的预后变量。然后，我们对由其GS和一致性状态定义的患者组的生化复发进行了生存分析。结果：在Pbx上GS 6的患者中，有681 / 1,847（36.86％）的患者在RP后升为GS 7或更高。 Pbx和RP符合GS 6的患者，手术切缘，包膜受累，精囊和淋巴结受累状态更为有利（P <0.0001）。经直肠超声（TRUS）前列腺体积较小的患者被发现具有较高的PSA密度，并且更有可能在RP时升级。多变量生存分析还预测，在控制其他相关协变量的情况下，GS 6与7/7或6/7或7/7一致的Pbx组织和RP标本的男性随着时间的推移会减少生化复发事件。结论：在最初被诊断为GS 6或7腺癌的前列腺癌患者中，Pbx组织和RP标本之间的GS差异很大。这种不一致在预测肿瘤学结局方面具有潜在的临床意义。

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