改良Gleason评分系统在前列腺癌术后患者预后评估中的意义  

Prognostic significance of modified Gleason scoring system after radical prostatectomy

作　　者：张胜捷[1] 姜伟[1] 袁选民[1] 张立进[1] 纪长威[1] 郭宏骞[1] 

机构地区：[1]南京大学医学院附属鼓楼医院泌尿外科,210008

出　　处：《中华泌尿外科杂志》2016年第5期344-348,共5页Chinese Journal of Urology

摘　　要：目的探讨改良Gleason评分系统在前列腺癌术后患者预后评估中的意义。方法回顾性分析2006年4月至2011年10月收治的168例前列腺癌患者的临床病理资料。年龄53～85岁，平均69岁。初始PSA4．59—36．12ng／ml，平均13．31ng／ml。168例按传统“三分法”Gleason评分：≤6分组50例，7分组86例，8—10分组32例。按改良的“五分法”Gleason评分：6分组50例，3＋4分组67例，4＋3分组19例，8分组15例，9—10分组17例。采用Kaplan—Meier法绘制各分组的生化复发生存曲线，应用Cox比例风险回归模型进行影响前列腺癌生化复发的多因素分析，ROC曲线法比较分析“五分法”与“三分法”对前列腺癌术后5年无生化复发生存率的预测价值。结果“五分法”各分组间比较，初始PSA值、病理分期、包膜外侵犯、精囊侵犯、淋巴结转移、切缘阳性率等差异均有统计学意义（P〈0．05）。随访7～98个月，中位时间68个月。6分、3＋4分、4＋3分、8分及9～10分组的5年无生化复发生存率分别为84．0％（42／50）、76．1％（51／67）、57．9％（11／19）、40．0％（9／15）、29．4％（5／17）。3＋4分组和4＋3分组的HR值分别为1．736和2．075（P均〈0．05）。“三分法”中≤6分组、7分组、8～10分组的5年无生化复发生存率分别为84．0％（42／50）、72．1％（62／86）、43．4％（14／62）。“五分法”的ROC曲线下面积为0．698（95％C10．609～0．788），“三分法”为0．674（95％C10．584～0．764），差异无统计学意义（P=0．06）。结论改良的“五分法”Gleason评分系统与前列腺癌的恶性程度及生存率明显相关，可对前列腺癌患者的预后做出准确的评估，可在一定程度上减少对Gleason评分3＋4分前列腺癌的过度医疗。Objective To analysis the modified Gleason scoring system for predicting the prognosis after radical prostatectomy. Methods A total of 242 patients who received radical prostateetomy from April, 2006 to October 2011 were recruited. The patients who lost follow-up or had adjuvant radiation or hormonal therapy or had visceral or bone metastasis were excluded, the remaining 168 patients were evaluated in the present study. The patients＂ age ranged from 53 to 85 years old （mean age 69 years old）. The mean PSA level was 13.31ng/ml （ ranging from 4. 59 to 36. 12 ng/ml）. According to the traditional Gleason scoring system, there were 50 patients in Gleason ≤ 6 group, 86 patients in Gleason 7 group and 32 patients in Gleason≥8 group. Patients were divided in five groups according to the modified Gleason scoring system. There were 50 patients in Gleason ≤6 group,67 in Gleason 3 ＋ 4 group, 19 in Gleason 4 ＋ 3 group, 15 in Gleason 8 group and 17 in Gleason 9-10 group. The biochemical-free-survival curve was drawn by Kaplan- Meier method and the multivariate Cox regression models were used to evaluate the clinical and pathological variables for the development of biochemical recurrence. ROC curve analysis was used to determine the predicted value for 5-year BCR of modified and traditional Gleason scoring. Results Significant differences were noted between the modified Gleason scoring groups and traditional Gleason scoring groups in PSA value （ P = 0. 005 ）, pathological stage （ P = 0. 002 ）, extraprostatic extension （ P = 0. 003 ）, seminal vesicle invasion （ P = 0. 004 ）, lymph node involvement （ P = 0. 049 ） and positive surgical margin （ P = 0. 006 ）. With amedian follow-up of 68 months（ ranging from 7 to 98 months） ,5-year BFS rates for men with Gleason grade ≤6,3 ＋ 4,4 ＋ 3,8 and 9-10 tumours on RP pathology were 84.0% （42/50） ,76. 1% （51/67） ,57. 9% （ 11/19 ） ,40.0% （ 9/15 ） ,29.4% （ 5/17 ）, respectively. On multivariate analysis, the HR value of G

关 键 词：改良Gleason评分 前列腺癌根治 生化复发 

分 类 号：R737.25[医药卫生—肿瘤]