前列腺根治性切除术后ISUP分级升高的危险因素

Risk Factors of ISUP Grade Upgrading after Radical Prostatectomy

目的研究分析根治性前列腺切除术前后基于2014年国际泌尿病理协会分级系统病理分级升高的相关因素。方法回顾性分析杭州市第一人民医院2012年1月~2020年8月收治的335例前列腺癌患者的临床病理资料,患者平均年龄为69.0±6.7岁,身高为167.9±5.5cm,体重为66.6±9.7kg,体重指数为23.6±3.0kg/m^(2);中位前列腺特异性抗原(prostate specific antigen,PSA)为10.57(0.01~182.30)ng/ml,游离PSA为1.28(0.01~16.92)ng/ml,前列腺体积为35.59(7.10~100.37)ml,PSA密度为0.32(0.01~4.55),穿刺针数为10(6~13)针,穿刺Gleason评分为7(6~10)分,穿刺病理基于2014年国际泌尿病理协会(international society of urologic pathology,ISUP)分级系统的分级为2(1~5)级,其中1级126例(37.6%),2级75例(22.4%),3级58例(17.3%),4级47例(14.0%),5级29例(8.7%)。穿刺距离根治性前列腺切除术(radical prostatectomy,RP)间隔中位天数为14(7~499)天,RP术后切缘阳性165例(49.3%),RP术后淋巴结转移21例(6.3%),RP术后精囊腺侵犯36例(10.7%)。335例患者均行RP术,并根据是否发生RP术后ISUP病理升级进行分组,分为病理升级组和病理未升级组,采用多因素Logistic回归分析研究RP术后导致病理升级的独立影响因素。结果本研究335例RP手术后病理降级的43例(12.9%),病理一致的191例(57.0%),病理升级的101例(30.1%)。多因素Logistic回归分析发现前列腺体积(OR=0.979,P=0.028)、切缘情况(OR=0.435,P=0.002)、穿刺时Gleason评分(OR=0.556,P<0.001)、穿刺病理ISUP分级(OR=0.661,P<0.001)是RP术后病理升级的独立影响因素。前列腺体积、切缘情况、穿刺时Gleason评分、穿刺病理ISUP分级ROC曲线下面积分别为0.594(95%CI:0.528~0.660)、0.421(95%CI:0.356~0.486)、0.757(95%CI:0.706~0.808)、0.774(95%CI:0.725~0.824)。结论前列腺体积、切缘情况、穿刺病理Gleason评分以及穿刺病理ISUP分级是RP术后病理ISUP分级升高的独立影响因素。

Objective To study and analyze the risk factors of elevated pathological grades based on the 2014 International Urological Pathology Association(ISUP)grading system after radical prostatectomy(RP).Methods A total of 335 patients who underwent biopsy and radical prostatectomy in Hangzhou First People′s Hospital from January 2012 to August 2020 were analyzed retrospectively.The average age was 69.0±6.7 years,Height was 167.9±5.5cm,weight was 66.6±9.7kg,body mass index(BMI)was 23.6±3.0kg/m^(2),median Prostate specific antigen(PSA)was 10.57(0.01-182.30)ng/ml,fPSA was 1.28(0.01-16.92)ng/ml,prostate volume was 35.59(7.10-100.37)ml,PSA density(PSAD)was 0.32(0.01-4.55),number of biopsy core examine was 10(6-13).The Gleason score of biopsy was 7(6-10),and the ISUP grade of biopsy was 2(1-5),including 126 cases of grade 1(37.6%),75 cases of grade 2(22.4%),58 cases of grade 3(17.3%),47 cases of grade 4(14.0%)and 29 cases of grade 5(8.7%).The above 335 patients were treated with RP.The median days between biopsy and RP were 14(7-499)days.165 cases(49.3%)had positive tumor margin after RP,21 cases(6.3%)had lymph node metastasis after RP,and 36 cases(10.7%)had seminal vesicle gland invasion after RP.335 patients underwent RP and were divided into Gleason grouping upgrading(GGU)group and non GGU group according to whether there was ISUP pathological upgrading after RP.Logistic regression analysis was used to predict the independent risk factors of pathological upgrading after RP.Results Among 335 patients with prostate cancer after RP,43 cases(12.9%)were pathologically degraded,191 cases(57.0%)were pathologically consistent,and 101 cases(30.1%)were pathologically upgraded.After Logistic regression analysis of relevant clinicopathological data of 335 patients,it can be concluded that prostate volume(OR=0.979,P=0.028),tumor margin(OR=0.435,P=0.002),Gleason score during biopsy(OR=0.556,P<0.001)and ISUP grade of biopsy(OR=0.661,P<0.001)were independent influencing factors for pathological upgrading after RP.The area under the ROC curve of the prostate volume,tumor margin,Gleason score of biopsy and ISUP grade of biopsy puncture pathological ISUP grade were 0.594(95%CI:0.528-0.660),0.421(95%CI:0.356-0.486),0.757(95%CI:0.706-0.808)and 0.774(95%CI:0.725-0.824).Conclusion prostate volume,tumor margin,Gleason score of biopsy and ISUP grade of biopsy are independent factors affecting pathology upgrading grade after RP.