根治性前列腺切除术后病理大切片与常规切片的对比分析

Comparative analysis of whole mount processing and conventional sampling of radical prostatectomy specimens

背景与目的:在根治性前列腺切除术(radical prostatectomy,RP)组织标本中,应用病理大切片技术可以全面观察组织,其在病理诊断、形态学研究方面拥有独特的优势。但是由于制作技术、设备限制、工作量较大等原因,目前在临床上尚未常规开展。本研究通过比较RP后行常规切片及病理大切片患者的临床及病理变量,评价RP后病理大切片技术在前列腺癌诊断中的意义。方法:选择2012年12月—2014年2月在复旦大学附属肿瘤医院行RP后做病理大切片的229例前列腺癌患者作为研究组,同时选取2010年1月—2012年6月行RP后做常规病理切片的393例前列腺癌患者作为对照组,对比分析包括两组患者年龄,术前PSA值,术前是否接受新辅助内分泌治疗,前列腺癌确诊方式,确诊时Gleason评分、临床分期,RP后Gleason评分、病理分期、手术切缘、前列腺包膜外侵犯、精囊侵犯、术后盆腔淋巴结转移等变量。结果:两组患者术前临床及病理变量:RP后病理Gleason评分、病理分期、前列腺包膜外侵犯情况、术后盆腔淋巴结转移差异均无统计学意义(P>0.05),但是研究组患者手术切缘及精囊侵犯的阳性率明显高于对照组,差异有统计学意义(26.2%vs17.6%,P=0.010;23.1%vs 17.0%,P=0.025)。结论:应用病理大切片技术可明显提高前列腺标本切缘阳性及精囊侵犯的阳性检出率,因此病理大切片技术值得在前列腺癌病理诊断中推广。

Background and purpose：To perform whole mount technique in the diagnosis of the prostate cancer could provide orientation to the specimen. Whole mount technique has great value in pathologic diagnosis and morphological research. However, limited by the specimen-making technique, shortage of equipment and heavy workload, this technique has not been generally accepted in China. The aim of this study was to evaluate the signiifcance of whole mount technique in the diagnosis of the prostate cancer by comparing the clinical and pathological variables between whole mount patients and conventional ones after radical prostatectomy （RP）.Methods：A total number of 229 patients’ whole mount RP specimens were recruited in the study from Dec. 2012 to Feb. 2014. The control group included 393 patients’ specimens which underwent conventional sampling from Jan. 2010 to Jun. 2012. We compared the clinical and pathological variables between the groups, including age, preoperative PSA level, methods of diagnosis, preliminary diagnostic Gleason score, clinical T stage, postoperative Gleason score, pathological T stage, positive surgical margin, extraprostatic extension, seminal vesicle invasion and pelvic lymph node metastasis.Results：Two groups shared similar preoperative parameters. Also there was no signiifcant difference between the whole mount and the conventional sampling groups in postoperative Gleason score, pathological T stage, extraprostatic extension and pelvic lymph node metastasis. However, positive surgical margin and seminal vesicle invasion rates were much higher in the whole mount group than the control one and both of the differences reached statistical signiifcance （26.2%vs 17.6%, 23.1%vs 17.0%;P=0.010, 0.025）Conclusion：After compared the clinical and pathological variables, we could conclude that whole mount technique has prevalence in the diagnosis of the positive surgical margin and seminal vesicle invasion compared with the conventional sampling technique. Thus, whole mount technique should be strongly recommended in the diagnosis of prostate cancer.