前列腺癌根治术后Gleason评分升级的影响因素分析（基于2014版ISUP分组）

doi:10.3969/j.issn.1009-976X.2022.04.012

摘要/Abstract

摘要： 目的在2014版ISUP分组的基础上,探讨前列腺癌根治术后Gleason升级的影响因素。方法回顾性收集2016~2021年于新疆医科大学第一附属医院行前列腺癌根治术的临床数据189例,根据前列腺癌根治术后Gleason是否较前列腺穿刺时升高,分为Gleason升级组（GGU组）60例及Gleason非升级组（非GGU组）129例。单因素分析及多因素Logistic回归对比两组资料的差异。结果单因素分析中穿刺肿瘤组织长度、Gleason主要区域评分及Gleason次要区域评分与GGU有关（P<0.05）,多因素Logistic回归后,高血压病史（OR=2.651）、Gleason主要区域评分（OR=4.186）、穿刺肿瘤组织长度（OR=10.989）及穿刺阳性率（OR=3.684）与GGU有关（P<0.05）。结论高血压病史、穿刺标本Gleason主要区域评分、标本中肿瘤组织长度及穿刺阳性率可能与GGU的风险相关。

关键词: 前列腺癌根治术, 前列腺癌, Gleason评分, 穿刺活检, 病理升级

Abstract: Objective To explore the influencing factors of Gleason upgrade after radical prostatectomy on the basis of ISUP grouping in 2014 edition. Methods Clinical data of 189 patients who underwent radical prostatectomy in the First Affiliated Hospital of Xinjiang Medical University from 2016 to 2021 were retrospectively collected. According to whether Gleason after radical prostatectomy was higher than that during prostate puncture, 60 cases were divided into Gleason Grade Upgrading group （GGU group） and 129 cases were Gleason Grade non-Upgrading group （non-GGU group）. Univariate analysis and multivariate Logistic regression were performed to compare the data differences between the two groups. Results In univariate analysis, the length of punctured tumor tissue, Gleason major area score and Gleason minor area score were related to GGU （P<0.05）. After Logistic regression, the history of hypertension （OR=2.651）, Gleason major area score （OR=4.186）, tumor tissue length （OR=10.989） and positive rate of biopsy （OR=3.684） were related to GGU （P<0.05）. Conclusion History of hypertension, Gleason major area score of biopsy specimens, tumor tissue length in specimens, and positive biopsy rate may be associated with the risk of GGU.

Key words: radical prostatectomy, prostate cancer, Gleason scores, needle biopsy, pathology upgrade

中图分类号:

R737.25

宋鸿文, 王继鑫, 阿斯木江·阿不拉, 王玉杰, 王文光. 前列腺癌根治术后Gleason评分升级的影响因素分析（基于2014版ISUP分组）[J]. 岭南现代临床外科, 2022, 22(04): 378-383.

SONG Hong-wen, WANG Ji-xin, Asimujiang Abula, Wang Yu-jie, WANG Wen-guang. Analysis of influencing factors of Gleason grade upgrading after radical prostatectomy（Based on 2014 ISUP grouping）[J]. Lingnan Modern Clinics In Surgery, 2022, 22(04): 378-383.

参考文献

[1] Sehn JK.Prostate Cancer Pathology:Recent Updates and Controversies[J]. Mo Med, 2018, 115(2):151-155.
[2] 欧阳仪, 陈东, 李永红,等. 根治性前列腺切除术后ISUP病理分级较前列腺穿刺病理分级升高的预测因素[J]. 中华泌尿外科杂志, 2020, 41(2):114-119.
[3] 冀易隆, 王向阳, 姬彤宇, 等. 根治性前列腺切除术后Gleason分级升高的相关因素及预测列线图模型的建立[J]. 实用临床医药杂志, 2021, 25(14):69-74.
[4] Soenens C, Dekuyper P, De Coster G, et al.Concordance Between Biopsy and Radical Prostatectomy Gleason Scores:Evaluation of Determinants in a Large-Scale Study of Patients Undergoing RARP in Belgium[J]. Pathol Oncol Res, 2020, 26(4):2605-2612.
[5] Altok M, Troncoso P, Achim MF, et al.Prostate cancer upgrading or downgrading of biopsy Gleason scores at radical prostatectomy:prediction of “regression to the mean” using routine clinical features with correlating biochemical relapse rates[J]. Asian J Androl, 2019, 21(6):598-604.
[6] De Nunzio C, Brassetti A, Simone G, et al.Metabolic syndrome increases the risk of upgrading and upstaging in patients with prostate cancer on biopsy:a radical prostatectomy multicenter cohort study[J]. Prostate Cancer Prostatic Dis, 2018, 21(3):438-445.
[7] Gleason DF.Classification of prostatic carcinomas[J]. Cancer Chemother Rep, 1966, 50(3):125-128.
[8] De Nunzio C, Pastore AL, Lombardo R, et al.The new Epstein gleason score classification significantly reduces upgrading in prostate cancer patients[J]. Eur J Surg Oncol, 2018, 44(6):835-839.
[9] 刘奥, 黄海, 张传杰, 等. 基于2014 ISUP分组预测根治性前列腺切除术后病理升级的列线图的建立与内部验证[J]. 中华泌尿外科杂志, 2020, 41(4):297-302.
[10] Kim H, Jung G, Kim JH, et al.Role of prostate health index to predict Gleason score upgrading and high-risk prostate cancer in radical prostatectomy specimens[J]. Sci Rep, 2021, 11(1):17447.
[11] Zhang B, Wu S, Zhang Y, et al.Analysis of risk factors for Gleason score upgrading after radical prostatectomy in a Chinese cohort[J]. Cancer Med, 2021, 10(21):7772-7780.
[12] De Nunzio C, Presicce F, Tubaro A.Inflammatory mediators in the development and progression of benign prostatic hyperplasia[J]. Nat Rev Urol, 2016, 13(10):613-626.
[13] Wenzel M, Preisser F, Wittler C, et al.Correlation of MRI-Lesion Targeted Biopsy vs. Systematic Biopsy Gleason Score with Final Pathological Gleason Score after Radical Prostatectomy[J]. Diagnostics (Basel), 2021, 11(5).
[14] Gupta N, Bivalacqua TJ, Han M, et al.Evaluating the impact of length of time from diagnosis to surgery in patients with unfavourable intermediate-risk to very-high-risk clinically localised prostate cancer[J]. BJU Int, 2019, 124(2):268-274.

[1]	陈秀凤, 卜庆丰, 张杰. 基于多参数磁共振成像的PI-RADS第二版评分联合f/t PSA及PSAD在前列腺癌早期筛查中的预测价值[J]. 岭南现代临床外科, 2021, 21(02): 213-216.
[2]	袁红, 胡小芳, 陈业辉, 李淑霞. 基于微视频健康教育在前列腺癌根治术后留置尿管患者护理中的初步观察[J]. 岭南现代临床外科, 2020, 20(05): 677-680.
[3]	陈美贤, 杨雪莹, 廖朝霞, 叶西就, 陆福鼎. “深肌松”在肥胖患者行机器人辅助腹腔镜下根治性前列腺癌切除术中的应用观察[J]. 岭南现代临床外科, 2020, 20(04): 468-471.
[4]	袁小旭, 邱剑光, 朱雨沫, 林雪花, 庞国福, 邓建, 谢群. 经会阴前列腺穿刺与经直肠前列腺穿刺活检在前列腺癌诊断的初探[J]. 岭南现代临床外科, 2020, 20(04): 484-487.
[5]	陈美贤，陆福鼎*，廖朝霞，叶西就，黄海明. 丙泊酚联合瑞芬太尼在小儿肝穿刺活检中的应用[J]. 岭南现代临床外科, 2019, 19(06): 686-693.
[6]	胡丽娟，戴奇山，胡建波*. 89锶、唑来膦酸及99锝-亚甲基二膦酸盐治疗老年前列腺癌骨转移的临床观察[J]. 岭南现代临床外科, 2019, 19(04): 437-446.
[7]	胡丽娟，戴奇山，胡建波*. 阿比特龙联合泼尼松治疗老年转移性去势抵抗前列腺癌的临床观察[J]. 岭南现代临床外科, 2019, 19(03): 333-336.
[8]	尤洪科1，文博1，尹永华1. 去泛素化酶3在前列腺癌中的表达及其对前列腺癌细胞生物学特性的影响[J]. 岭南现代临床外科, 2019, 19(03): 337-340.
[9]	叶秀钦，丁志敏，董发进，魏章洪，刘慧玉，吴淮宇，徐金锋*. 经直肠实时弹性成像引导靶向穿刺在前列腺病变的应用价值研究[J]. 岭南现代临床外科, 2019, 19(02): 195-198.
[10]	何江耀，王健文，夏丽丽. 术前针刺活检与手术标本分类的一致性对早期乳腺癌治疗的影响[J]. 岭南现代临床外科, 2019, 19(01): 64-66.
[11]	梅静思，胡越，顾然，刘凤桃，王红莉，蒋小芳，申时雨，龚畅*. 超声联合空芯针穿刺活检在原发性乳腺癌腋窝淋巴结转移中的诊断价值[J]. 岭南现代临床外科, 2018, 18(05): 509-513.
[12]	林春浩，赖义明，彭圣萌，黄海，郭正辉. Polo样激酶3在前列腺癌中的表达及临床意义[J]. 岭南现代临床外科, 2018, 18(02): 133-136.
[13]	韦兴华林煜荣杨文俊谢克基汤平. PSA密度在PSA 2.5~10.0 ng/mL和10.1~20.0 ng/mL患者前列腺癌诊断价值的多中心研究[J]. 岭南现代临床外科, 2016, 16(03): 327-330.
[14]	萧聪勤胡建波周一南. 染料木黄酮诱导前列腺癌DU-145细胞凋亡的研究[J]. 岭南现代临床外科, 2016, 16(02): 215-218.
[15]	万跃平习明万颂华伟曾昭昌刘远灵林卓远吴永定杨盛帮韩兆冬. 前列腺癌组织中TRIB1基因和蛋白异常表达与患者不良预后的相关性[J]. 岭南现代临床外科, 2016, 16(01): 87-91.