| 张 莉,周 丽,季星利,崔家旗,杨 帆.穿刺单针阳性前列腺癌的术后病理特征分析[J].,2022,(23):4591-4595 |
| 穿刺单针阳性前列腺癌的术后病理特征分析 |
| Clinicopathologyic Analysis of Prostatic Cancer with Single Positive Core Biopsy after Radical Prostatectomy |
| 投稿时间：2022-04-29 修订日期：2022-05-25 |
| DOI：10.13241/j.cnki.pmb.2022.23.038 |
| 中文关键词: 单针阳性 前列腺癌 病理特征 Gleason评分 |
| 英文关键词: Single needle positive Prostate cancer Pathological features Gleason score |
| 基金项目:成都市卫健委基金项目（2020120） |
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| 中文摘要: |
| 摘要 目的：回顾性分析单针阳性患者的术后病理特征及Gleason评分的变化情况。方法：收集2018年9月-2020年6月在本院泌尿外科行穿刺活检，病理诊断为单针阳性的86例前列腺癌患者展开研究，按患者年龄、手术前PSA检测值、Gleason评分、临床分期（cTNM）进行分组，其中：年龄组（年龄≥70岁、年龄＜70岁）、术前PSA组（PSA＜10 ng/mL、≥10 ng/mL）、术前Gleason评分组（6分、3+4=7分、4+3=7分、≥8分）、临床分期组（cT1期组、cT2期组）。所有患者均采用腹腔镜下前列腺癌根治术和单针穿刺活检，观察纳入患者的基线资料，比较分析不同组别患者术后病理特征的差异和临床意义。结果：不同年龄患者病理特征无差异，PSA≥10 ng/mL组Gleason评分≥7分和Gleason评分升级患者占比显著高于PSA＜10 ng/mL组（P＜0.05）；cT2期组占比较低（P＜0.05）；cT2期组患者Gleason评分≥7分患者占比显著高于cT1期组（P＜0.05），但两组切缘阳性和Gleason评分升级相比无统计学意义（P＞0.05）；不同Gleason评分患者术后pT0、切缘阳性、Gleason评分升级差异无统计学意义（P＞0.05）；不同Gleason评分患者术后病理分期差异有统计学意义，Gleason评分为4+3=7分患者病理分期＞2显著高于6分、3+4=7分和≥8分（P＜0.05）；Logistic回归分析结果显示，年龄＞70岁、PSA≥10 ng/mL、cT2期和Gleason评分≥7分是影响术后病理特征的主要危险因素（P＜0.05）。结论：前列腺单针阳性患者存在Gleason评分术后升高情况，部分患者伴有切缘阳性、病理分期≥T2特征，所以临床中无法将穿刺单针阳性作为前列腺癌患者低风险检测指标，需要结合患者其它各项指标对其进行个体化治疗方案。 |
| 英文摘要: |
| ABSTRACT Objective: To retrospectively analyze the pathological features and Gleason score of single needle positive patients. Methods: From September 2018 to June 2020, 86 patients with prostate cancer who underwent puncture in our urology department were selected for the study. All patients were divided into groups according to different risks of single needle biopsy and ridical proststectomy, including Age Group (age ≥70, age < 70) , preoperative PSA group (PSA < 10 ng/mL, ≥10 ng/mL), preoperative Gleason score group (6, 3+4=7, 4+3=7, ≥8), clinical staging group (CT1 group, CT2 group). Laparoscopic radical prostatectomy and needle biopsy were performed in all patients, and baseline data including age, PSA, educational level, income and pathological stage were observed, the pathological characteristics of different age, PSA, clinical stage and Gleason score after operation, The influencing factors of postoperative pathological characteristics of patients were analyzed by multiple factors. Results: There were 8 patients with PT0, 12 patients with positive margin, 6 patients with ≥2 stage, 47 patients with ≥7 Gleason score and 32 patients with upgraded Gleason score The results showed that there was no significant difference in pathological characteristics between the patients aged ≥70 years and those aged <70 years (P>0.05) The rate of Gleason score ≥7 and Gleason score upgrade in PSA ≥10 ng/mL group was significantly higher than that in PSA < 10 ng/mL group (P<0.05), and there was no significant difference in other pathological features between the two groups (P>0.05). The rate of PT0 in CT1 group was significantly higher than that in CT2 group (P<0.05) The rate of Gleason score ≥7 in CT2 group was significantly higher than that in CT1 group (P<0.05), but there was no significant difference between the two groups (P>0.05) There were no significant differences in PT0, margin positivity and Gleason score among patients with different Gleason scores (P>0.05), and there were significant differences in pathological stages among patients with different Gleason scores, the pathological stage > 2 of Gleason Score 4+3=7 was significantly higher than 6, 3+4=7 and ≥8(P<0.05); Logistic regression analysis showed that age>70 years old, PSA≥10 ng/mL, cT2 stage and Gleason score≥7 were the main risk factors affecting postoperative pathological characteristics (P<0.05). Conclusion: The Gleason score is higher in patients with single needle positive prostate cancer, and some patients have margin positive and pathological stage ≥ t 2. Therefore, the single needle positive prostate cancer can not be used as a low-risk indicator in clinic, patients need to be combined with other indicators of their individual treatment program. |
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