融合靶向穿刺单针阳性前列腺腺癌根治术后不良病理事件发生危险因素分析  

Analysis of risk factors for adverse pathological events after radical resection in prostate adenocarcinoma fusion targeted biopsy with single-core

作　　者：王文超[1,2] 付尧 王雪迪[2] 郑重 周强[2] 李丹燕[3] 樊祥山 史炯[2] WANG Wen-chao;FU Yao;WANG Xue-di;ZHENG Zhong;ZHOU Qiang;LI Dan-yan;FAN Xiang-shan;SHI Jiong(Department of Pathology,Taizhou People's Hospital,Taizhou 225300,China;Nanjing Drum Tower Hospital,Nanjing 210008,China)

机构地区：[1]泰州市人民医院病理科,江苏泰州225300 [2]南京鼓楼医院病理科,江苏南京210008 [3]南京鼓楼医院影像科,江苏南京210008

出　　处：《中华肿瘤防治杂志》2022年第4期302-306,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的探讨前列腺融合靶向穿刺单针或单部位阳性患者术后分级分组变化及不良病理事件发生的影响因素。方法应用电子病历报告系统收集2017-01-01—2020-08-31南京鼓楼医院在前列腺融合靶向穿刺标本中确诊为单针或单部位阳性的194例前列腺癌患者临床资料。分析术前前列腺核磁共振成像(MRI)和数据系统(PI-RADS)评分与单针阳性患者术前及术后临床病理关系,Kappa检验评价根治术后出现病理Gleason评分和分级分组之间非一致性,二元Logistic单因素和多因素回归分析探讨影响术后评分升级及出现术后不良病理事件(切缘阳性、精囊腺侵犯和淋巴结转移)的危险因素。结果前列腺MRI PI-RADS评分与穿刺病理分级分组(χ^(2)=4.979,P=0.026)和穿刺标本肿瘤百分比(χ^(2)=19.494,P<0.001)间差异有统计学意义。仅45例在系统穿刺标本中阳性,86例在靶向穿刺标本中阳性,其中靶向穿刺阳性患者术前PI-RADS评分稍高。穿刺标本与根治标本Gleason评分一致的共84例(62.69%),根治性切除标本分级分组升级的34例(25.37%),降级的16例(11.94%),二者评分一致性较差(Kappa=0.392)。多因素分析显示,穿刺病理分级分组(OR=10.835,95%CI为2.393~49.052,P=0.002)是影响根治标本Gleason评分升高的独立危险因素,穿刺标本肿瘤百分比大于单条组织长度20.00%(OR=0.324,95%CI为0.120~0.873,P=0.026)是出现术后不良病理事件的可能危险因素。结论前列腺MRI PI-RADS评分对于低级别癌预测效果差,靶向穿刺要与系统穿刺互为补充。前列腺穿刺单针阳性与根治术后的病理结果一致性较差,术前穿刺病理结果分级分组是影响根治标本Gleason评分升高的主要危险因素,穿刺标本肿瘤百分比高可能是造成术后出现不良病理事件的危险因素。Objective To explore the postoperative classification and grouping changes of patients with single needle or single site positive prostate fusion targeted puncture and the influencing factors of adverse pathological events.Methods The electronic case report system was used to collect the clinical data of 194patients with prostate cancer diagnosed as single needle or single site positive in prostate fusion targeted puncture specimens in Nanjing Drum Tower Hospital from January 1,2017to August 31,2020.The relationship between preoperative magnetic resonance prostate imaging report and data system(RI-RADS)score and postoperative clinicopathology of single needle positive patients was tested and analyzed.Kappa test was used to evaluate the inconsistency between pathological Gleason score and classification after radical operation;binary logistic univariate and multivariate regression analysis were used to explore the risk factors of postoperative score upgrading and postoperative adverse pathological events(positive margin,seminal vesicle gland invasion and lymph node metastasis).Results There was a significant positive correlation between PI-RADS score and pathological grade group(χ^(2)=4.979,P=0.026),tumor percentage(χ^(2)=19.494,P<0.001)respectively.Totally 45cases were positive only in systematic puncture specimens and 86cases were positive in targeted puncture specimens.The preoperative PI-RADS score of patients with positive targeted puncture was slightly higher.The patients with targeted biopsy had slightly higher preoperative PI-RADS score.Totally 84cases(62.69%)had the consistent Gleason score after radical resection,34cases(25.37%)with the upgrade and 16cases(11.94%)with under grade score.Multivariate analysis showed grade group of biopsy was an independent risk factor for upgraded radical specimen(OR=10.835,95%CI:2.393-49.052,P=0.002).The percentage of tumor in biopsy specimen greater than 20.00%was risk factor for postoperative adverse pathological events(OR=0.324,95%CI:0.120-0.873,P=0.026).Conclusions

关 键 词：前列腺癌 PI-RADS 靶向活检 前列腺切除术 不良病理事件 

分 类 号：R737.25[医药卫生—肿瘤]