前列腺偶发癌的发病率与病理特点及其临床意义  

Incidence and pathological features of incidental prostate cancer and clinical significance thereof

作　　者：杨新宇[1] 夏同礼[1] 何群[1] 李文[1] 王静华[1] 苏晋伟[1] 李峻[1] 那彦群[1] 

机构地区：[1]北京大学第一医院泌尿外科,北京大学泌尿外科研究所100034

出　　处：《中华医学杂志》2007年第37期2632-2634,共3页National Medical Journal of China

摘　　要：目的探讨目前前列腺偶发癌的发病率、病理特点及其与前列腺癌临床诊治的关系。方法对北京大学泌尿外科研究所1999年1月至2005年8月间所有术前未诊断前列腺癌的全部前列腺标本进行回顾性研究,总结前列腺偶发癌的发病率,并对其病理特征及临床意义进行评价。结果北京大学泌尿外科研究所1999年1月至2005年8月间1483例前列腺标本中共检出前列腺偶发癌53例,其发病率为3.6%;病理分级为 Gleason 评分2(1+1)到9(4+5);体积为0.18mm^3到1440.00mm^3。其中体积小于0.5cm^3的无意义癌47例(占88.7%);体积大于0.5cm^3的有临床意义的前列腺癌6例(占11.3%)。有临床意义的前列腺癌仅见于 TURP 标本中。TURP 标本中20%的偶发癌为有临床意义的前列腺癌。有临床意义的前列腺偶发癌主要分布于前列腺移行区及中央区,其病理分级为 Gleason 评分3+4(2例),4+2(1例)及4+5(3例),肿瘤呈弥漫性分布,术前临床特点均为触诊和/或影象学检查(-),血 PSA 升高,穿刺(-)。结论现阶段前列腺偶发癌的发病率为3.6%,比20世纪80年代略有下降。前列腺偶发癌中有临床意义的前列腺癌占11.3%。导致这些有临床意义的前列腺癌术前未被临床诊断的原因与肿瘤的病理特征有关。Objective To investigate the morbidity and pathological features of incidental prostate cancer and their clinical significance. Methods 1483 prostate specimens obtained during operation, including transurethral resection of prostate （TURP） and total resection of the prostate, for the diagnoses of benign prostatic hypertrophy （BPH） or bladder cancer between January 1999 and August 2005 underwent pathological examination and 341312 and p63 immunohistochemical staining so as to detect incidental prostate cancer. The volume of incidental prostate cancer was calculated by the image analysis system. The clinical data were analyzed retrospectively. Comparison between the clinical and pathological feature of incidental prostate cancer was made. Results 53 cases of incidental prostate cancer, with the Gleason scores from 2 （ 1 ＋ 1 ） to 9 （4 ＋5） and the volumes from 0.18 to 1440.00 mm^3 were detected. The morbidity of incidental prostate cancer was 3.6%. The volume of 47 cases （88.7%） were less than 0.5 cm^3 as the threshold of insignificant cancer, and the volumes of 6 cases （ 11.3% ） were more than 0.5 cm^3. All incidental prostate cancers of clinical significance were detected in the TURP samples. Among the incidental prostate cancers found in the TURP samples 20% were clinically significant cancers. The clinically significant incidental cancers were located in the central or transitional zone with the Gleason scores of 3 ＋ 4 （2 cases）, 4 ＋ 2 （ 1 case）, or 4 ＋ 5 （3 cases）. These clinically significant cancers were of diffuse distribution, and their preoperative clinical features were negative in palpation/image examination, elevation of serum PSA, and negative in puncture examination. Conclusion Nowadays, the morbidity of incidental prostate cancer is lower than that of 1980s＇. Among the incidental cancers 11.3% were of clinical significance. That the preoperative clinical examination cannot find these clinical significant cancers is partially caused by the pathological fe

关 键 词：发病率 前列腺肿瘤 病理学 临床 

分 类 号：R737.25[医药卫生—肿瘤]