CAJ | 학술논문

目的通过对前列腺穿刺活检单针阳性并随之行前列腺根治手术患者的临床及病理参数进行分析,评估穿刺单针阳性前列腺癌的临床意义.方法对45例接受12针前列腺穿刺活检中单针阳性确诊为前列腺癌并随后行前列腺癌根治术的患者的临床及病理资料进行分析,评价手术前后病理结果的非一致性,分析肿瘤术后病理分级及分期升高、神经周围侵犯、切缘阳性等肿瘤被低估的可能危险因素.结果最终的根治病理显示,只有31.1％的患者为单侧前列腺癌.66.7％患者的术后分期升高;37.8％患者术后Gleason评分升高;31.1％患者术后切缘阳性.多因素Logistic回归分析显示,穿刺标本肿瘤组织百分率可能是肿瘤术后Gleason评分升高、术前临床分期低估及神经周围侵犯的危险因素.未发现患者的年龄、前列腺体积、术前血清前列腺特异性抗原(PSA)和PSA密度对肿瘤被低估有显著影响.结论大部分前列腺穿刺单针阳性患者的肿瘤负荷被低估.穿刺标本肿瘤组织百分率可能是肿瘤被低估的危险因素.目前尚无法在术前准确预测局灶或单侧前列腺癌.
목적 통과대전렬선천자활검단침양성병수지행전렬선근치수술환자적림상급병리삼수진행분석,평고천자단침양성전렬선암적림상의의.방법 대45례접수12침전렬선천자활검중단침양성학진위전렬선암병수후행전렬선암근치술적환자적림상급병리자료진행분석,평개수술전후병리결과적비일치성,분석종류술후병리분급급분기승고、신경주위침범、절연양성등종류피저고적가능위험인소.결과 최종적근치병리현시,지유31.1％적환자위단측전렬선암.66.7％환자적술후분기승고;37.8％환자술후Gleason평분승고;31.1％환자술후절연양성.다인소Logistic회귀분석현시,천자표본종류조직백분솔가능시종류술후Gleason평분승고、술전림상분기저고급신경주위침범적위험인소.미발현환자적년령、전렬선체적、술전혈청전렬선특이성항원(PSA)화PSA밀도대종류피저고유현저영향.결론 대부분전렬선천자단침양성환자적종류부하피저고.천자표본종류조직백분솔가능시종류피저고적위험인소.목전상무법재술전준학예측국조혹단측전렬선암.
Objective To explore the clinicopathological implications of single positive core prostate cancer.Methods A total of 45 patients with transrectal ultrasound (TRUS)-guided prostate biopsy were diagnosed with single positive core prostate cancer and subsequently underwent radical prostatectomy (RP).Their clinicopathological parameters were examined to identify the factors for disease upgrading or upstaging.Results On final pathology,only 31.1％ patients had unilateral prostate cancer.And 37.8％ patients experienced Gleason score upgrading,66.7％ patients had upstaging and 31.1％ were found positive surgical margins.On multivariable analyses,the percentage of positive cores was an independent predictor of stage upgrading and perineural invasion at RP pathology.Age,prostate volume and preoperative prostatespecific antigen/prostate-specific antigen density (PSA/PSAD) had no significant effect on underestimated tumor burden.Conclusions Most single positive core prostate cancer diagnosed by 12-core biopsy may be underestimated.The percentage of positive cores is an independent predictor of underestimated prostate cancer.Currently we have no instruments for accurately identifying microfocal or unilateral prostate cancer.