穿刺标本Gleason评分预测前列腺癌病理分级准确性的研究

目的 分析前列腺癌患者穿刺标本与根治术标本Gleason评分的相关性,探讨影响穿刺标本Gleason评分准确性的可能因素.方法 回顾性分析86例接受根治性前列腺切除术的前列腺癌患者资料,比较穿刺标本与根治术标本Gleason评分的符合情况,应用二分类Logistic回归分析筛选影响穿刺标本Gleason评分准确性的可能因素.结果 86例患者穿刺标本平均Gleason评分为6.1,根治术标本平均Gleason评分为6.5,穿刺标本与根治术标本Gleason评分相比,评分相符42例(48.8%),评分偏低32例(37.2%),评分偏高1 2例(14.0%),差异具有统计学意义(P＜0.05),偏差与患者年龄、血清PSA、前列腺体积、临床分期无显著相关性(P＞0.05),与穿刺针数(OR=2.905)及穿刺阳性率(OR=4.225)有显著相关(P＜0.05).结论 穿刺针数与穿刺阳性针数百分比是影响穿刺标本Gleason评分准确性的可能因素,增加前列腺穿刺活检针数将可能有助于提高穿刺标本预测前列腺癌病理分级的准确性.

Evaluation of the accuracy of biopsy Gleason score as predictors of histological grading of prostate cancer specimens

Objective To evaluate the effects of biopsy specimens and prostatectomy specimens on Gleason scores and analyze the possible related factors to the accuracy of biopsy Gleason scores.Methods A total of 86 patients diagnosed with prostate cancer by transrectal biopsy who underwent radical prostatectomy(RP) were enrolled in this retrospective study.The relationship between biopsy and prostatectomy Gleason score was evaluated.And the possible factors related to grading error of biopsy were analyzed.Results The mean Gleason score was 6.1 and 6.5 for biopsy and prostatectomy specimens, respectively.The biopsy Gleason score was identical to the prostatectomy specimen score in 48.8 % (42/86) of cases.While there was under-grading of the final tumor score in 32(37.2%) patients on biopsy as compared with the radical prostatectomy, while over-grading occurred in 12(14.0%) patients.There was no correlation of grading error with age, serum PSA level, prostatic volume and clinical stage (P＞ 0.05).While the number of biopsy cores and the percent of positive prostate biopsies correlated significantly with the discrepancy of Gleason scores.Conclusion The number of biopsy cores and the percent of positive prostate biopsies are the possible factors affecting the accuracy of biopsy scores.And these findings suggest that obtaining a greater number of biopsy cores contributes to improving the accuracy of the biopsy Gleason score for predicting the RP.