老年人移行区前列腺癌的临床病理学特征

Clinical pathological features of transition zone prostate cancer in the elderly

目的分析大切片病理所观察的移行区前列腺癌癌灶大小、分布及其肿瘤分级、分期的特征.方法回顾性分析,入选2017年7月至2020年3月行前列腺癌根治术且术后前列腺标本制作病理大切片患者129例.记录病理学病灶位置、最大径线、国际泌尿外科病理学会分级分组(ISUP);影像学病灶最大径线、前列腺影像报告和数据系统(PI-RADS)评分.对病理大切片与影像学诊断病灶进行逐一对应,分析位于不同分区的前列腺癌病理学特征和影像检出情况.结果129例前列腺癌根治术标本,大切片病理检出213个癌灶.同时位于外周区及移行区的癌灶21个(9.9%),最大径线(2.82±0.71)cm;外周区的癌灶85个(39.9%),最大径线(1.36±0.81)cm;移行区的癌灶107个(50.2%),最大径线(1.60±0.94)cm.位于移行区的癌灶较多,癌灶最大径线较大,不同区域病灶最大径线比较差异有统计学意义(P<0.05).64例MRI资料完整的患者中,大切片病理检查出105个癌灶,MRI共检查出75个癌灶,位于移行区的癌灶MRI检出率较低,评估癌灶大小与大切片病理检出癌灶比较,差异有统计学意义(P<0.05).对癌灶直径≥1.0 cm或癌灶国际泌尿病理学会(ISUP)分级分组2组及以上的主要病变进行分析,位于移行区的病灶MRI检出率较低,差异有统计学意义(P<0.05).结论前列腺癌移行区病灶比例高,且肿瘤径线更大.移行区的前列腺癌灶易临床和影像学检查中易漏诊,需要临床医生在诊疗过程中关注.

Objective To investigate the features of volume,distribution,grading and staging of prostate cancer(PCa)examined via whole-mount histopathology in transitional PCa.Methods A total of 129 PCa patients undergone radical prostatectomy(RP)between July 2017 and March 2020 whose whole-mount prostate specimens were prepared after surgery were retrospectively studied.Pathological data on tumor locations,diameters and classification of the International Society of Urologic Pathology(ISUP),radiological data on regions of interest(ROI)and scores of the Prostate Imaging and Reporting Data System(PI-RADS v2)were recorded.The results of pathological whole-mount sections and prostate imaging were compared,and the characteristics and detection rates of lesions in different prostate regions were analyzed.Results Of all 129 prostate specimens from RP,a total of 213 PCa lesions were detected through whole-mount histopathology.There were 21(9.9%)lesions involving both the peripheral zone(PZ)and the transition zone(TZ),with an average diameter of(2.82±0.71)cm.Of all lesions,85(39.9%)involved PZ and 107(50.2%)involved TZ,with an average diameter of(1.36±0.81)cm and of(1.60±0.94)cm,respectively.The percentage of lesions involving TZ was higher than that lesions involving PZ,with larger diameters(P<0.05).Of 64 patients with complete MRI data,105 PCa lesions were detected histopathologically by using whole mount sections,while 75 PCa lesions were detected by MRI,with a statistical difference(P<0.05).For lesions≥1.0 cm or lesions with an ISUP grade group≥2,the detection rate of MRI was lower in TZ lesions(P<0.05).Conclusions PCa lesions within TZ account for a large proportion and have a relatively large tumor dimeter.PCa lesions within TZ are more likely to be missed in clinical examinations and on MRI,and clinicians should pay close attention during diagnosis and treatment.