前列腺穿刺活检与根治切除病理的相关性分析

Correlation analysis of prostate biopsy and radical prostatectomy specimen

目的评价前列腺穿刺活检下前列腺癌(prostatic cancer,PCa)患者Gleason评分对肿瘤发生部位预测的可靠性,分析根治术后出现切缘阳性(positive surgical margins,PSM)的相关影响因素。方法前列腺癌患者72例,术前均行前列腺穿刺活检,并与根治切除术后的病理进行对比分析,应用统计软件分析各指标间的相关性。结果穿刺病理与根治切除病理的Gleason评分基本一致;穿刺阳性多集中在外周靠近底部的4点,穿刺结果提示的肿瘤分布与根治病理的肿瘤分布一致性较差。术前相关临床指标中,穿刺Gleason评分及穿刺阳性针数百分比对切缘阳性有独立的预测意义,穿刺各针中F、L两点与切缘阳性存在较高的相关性。结论前列腺穿刺Gleason可作为患者病理分级的有效依据;当穿刺Gleason评分>7.25,阳性针数比例>45.0%,穿刺阳性位置靠近前列腺尖部时手术后出现切缘阳性的可能性增加。

Objective To study the reliability of Gleason score by prostate biopsy with prostatic cancer（PCa）in prediction of tumor location and analyse related influencing factors of positive surgical margins after radical prostatectomy.Methods The retrospective study recruited 72 patients with PCa who had been diagnosed by trans rectal ultrasound-guided prostate biopsy,and eventually treated with laparoscopic radical prostatectomy.The correlation of each index were analyzed by statistical software.Results In this study,Kappa test indicated a good agreement that Gleason score between prostate biopsy and radical prostatectomy.Biopsy positive more focused on four peripheral points near the bottom.Biopsy tumor location was not suitable for predicting tumor distribution.Biopsy Gleason score and biopsy positive percentage in biopsy specimen were independent predictors of positive surgical margins.F and L points had good correlation with the positive surgical margins.Conclusion The biopsy Gleason score is a good evidence to pathological grading in patients.These information will lead to positive surgical margins rise possibly：needle biopsy Gleason score exceed 7.25,positive biopsy percentage more than 45% and the location positive biopsy close to prostate apex.