1995年至2014年中国前列腺癌Gleason评分变化趋势

Trends in Gleason scores of Chinese prostate carcinoma from 1995 to 2014

目的：研究1995年1月至2014年12月前列腺癌（prostate carcinoma,PCa）Gleason评分（Gleason score,GS）的变化趋势。方法：选取1995年1月至2004年12月（1995年至2004年）和2005年1月至2014年12月（2005年至2014年）875例PCa,研究其GS、主要分级和次要分级均值以及所占比例,患者年龄按〈60、60~69、70~79和≥80岁分组;患者标本类型按穿刺活检（needle biopsy,NB）、经尿道前列腺切除（transurethral resection of the prostate,TURP）和根治性前列腺切除（radical prostatectomy,RP）分组;组织学类型按腺泡癌和其他类型（包括萎缩癌、假增生性癌、泡沫癌、印戒细胞癌和导管癌等）分组;总前列腺特异性抗原（total prostate-specific antigen,t PSA）按〈20.0μg/L和≥20.0μg/L分组。观察不同时期年龄、标本类型、组织学类型和t PSA中GS均值和比例,用SPSS17.0软件进行统计学分析。结果：与1995年至2004年相比,2005年至2014年GS、主要分级和次要分级均值分别降低0.32（P=0.003）、0.19（P=0.001）和0.12（P=0.016）。GS≤6分比例增加10.9%（P=0.003）,≥8分比例下降14.0%（P〈0.001）,7分比例差异没有统计学意义;主要分级≤3级比例增加12.8%（P=0.001）,4级比例下降7.4%（P=0.037）,5级比例下降5.5%（P=0.007）;次要分级≤3级比例增加7.6%（P=0.037）,而4级和5级差异没有统计学意义。结论：中国PCa中GS呈现下降趋势,这是近20年中国PCa显著特点之一;标本类型和年龄是影响GS的重要因素,而组织学类型和t PSA对GS影响较小。

Objective： To assess the changing trends in Gleason score（ GS） of Chinese prostate carcinoma（ PCa） from January 1995 to December 2014. Methods： In the study,875 patients admitted to hospital from January 1995 to December 2004（ 1995- 2004） and from January 2005 to December 2014（ 2005- 2014） were divided into two groups. The mean levels and proportions of GS,primary and secondary grades were studied. The patients were divided into four groups according to age： 60,60-69,70- 79 and ≥80 years. Types of specimen included needle biopsy（ NB）,transurethral resection of the prostate（ TURP） and radical prostatectomy（ RP）. Histological types were made up by acinar carcinoma and other types（ including atrophic,pseudohyperplastic,foam,signet ring cell and ductal carcinoma,and so on）. The total prostate-specific antigen（ t PSA） involved groups of 20. 0 μg / L and ≥20. 0 μg / L. We observed the mean levels and proportions of GS in age,types of specimen,histological types and total prostate-specific antigen in different periods,and used SPSS 17. 0 software for statistical analysis. Results： Compared with 1995- 2004,the mean levels of GS,primary and secondary grades decreased 0. 32（ P = 0. 003）,0. 19（ P = 0. 001） and 0. 12（ P = 0. 016） in 2005- 2014,respectively.The proportions of ≤6 in GS increased 10. 9%（ P = 0. 003）,and ≥8 decreased 14. 0%（ P〈0. 001）.The difference of GS 7 was not statistically significant. In the primary grade,the ratio of grades≤3 increased 12. 8%（ P = 0. 001）,and grade 4 decreased 7. 4%（ P = 0. 037）,grade 5 decreased 5. 5%（ P = 0. 007）. The ratio of secondary grades≤3 increased 7. 6%（ P = 0. 037）. The difference of grades4 and 5 was not statistically significant. Conclusion： GS in Chinese patients with PCa showed a downward trend,which is one of the notable features in the past 20 years in China. The types of specimen and age are important factors in GS,while the histological types and t PSA have less impact on the GS.