临床诊断与集团筛查前列腺癌的病理学特征比较

Comparison of pathological features of prostate cancer between mass screening patients and clinical patients

目的:通过对临床诊断与集团筛查前列腺癌的病理学特征的比较,探讨人群筛查前列腺癌的必要性。方法:107例前列腺癌组织,其中51例为临床病理标本,56例为经前列腺特异抗原(PSA)筛查后发现的病理标本。其中7例前列腺上皮内瘤(PIN)均来自集团筛查的标本。应用Gleason分级与评分标准进行病理学分析。结果:①筛查组前列腺癌的Gleason分级明显低于临床组(χ2=48.22,P<0.001)。②筛查组前列腺癌的Gleason评分明显低于临床组(χ2=24.55,P<0.001)。③筛查组前列腺癌的分化程度明显高于临床组(χ2=22.46,P<0.001)。④最典型的PIN仅见于集团筛查因PSA含量进行性增高接受活检穿刺患者标本中。结论:人群筛查病例中病理组织学变化以中期的中分化癌为多见,而临床病例中则以晚期的低分化癌为主,PSA集团检查有益于前列腺癌的早期发现。

Objeotive To investigate the role of the mass screening by comparing the pathological features of prostate cancer between mass screening patients and clinical patients. Methods 107 cases of prostate cancer （including 51 patients from clinical diagnosis and 56 patients from mass screening） and 7 cases of prostate intraepithelial neoplasia （PIN, from mass screening） were analyzed using the Gleason＇s grade system. Results （1） Gleason＇ s grade of prostate cancer in mass screening group was lower than that in clinical diagnosis group （χ^2 =48.22, P〈0. 001）; （2） Gleason＇ s scores of prostate cancer in mass screening group were lower than those in clinical diagnosis group （χ^2=24. 55, P〈0. 001）; （3） Differentiated degrees of prostate cancer in mass screening group were higher than those in clinical diagnosis group （χ^2=22.46, P〈0. 001） ; （4） The typical PIN was found only in mass screening group. Conolusion In mass screening group the moderately differentiated carcinoma is the most common type of prostate cancer, but in clinical diagnosis group the poorly differentiated carcinoma is most. General investigation for prostate cancer is benefit to find caner of early stage.