膀胱前列腺切除术中偶发前列腺癌的临床病理特点及前列腺标本规范化取材的意义  

Influence of standardized specimen handling on the detection rate of incidental prostatic carcinoma and clinicopathological characteristics in radical cystoprostatectomy specimens

作　　者：王云帆[1] 龚苗子[1] 王跃[1] 缪琦[1] 张晋夏[1] WANG Yun-fan;GONG Miao-zi;WANG Yue;MIAO Qi;ZHANG Jin-xia(Department of Pathology,Peaking Universisity Shougang Hospital,Beifing 100144,China)

机构地区：[1]北京大学首钢医院病理科,北京100144

出　　处：《诊断病理学杂志》2018年第9期635-639,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的观察膀胱前列腺切除术标本中偶发前列腺癌的检出率、临床病理特点及术后前列腺标本规范化取材对其检出率的影响。方法收集73例行膀胱前列腺切除术膀胱癌患者的临床病理资料,观察偶发前列腺癌的临床病理特征,并对比前列腺标本全部取材与部分取材间前列腺癌的检出率。结果 73例患者中,26例(35.6%)术后病理诊断合并前列腺癌,多数为前列腺腺泡腺癌(84.6%);Gleason评分≤6分(预后分组1组)16例(72.7%),Gleason评分3+4=7分(预后分组2组)4例(18.2%),Gleason评分4+3=7分(预后分组3组)2例(9.1%);20例(90.9%)局限于前列腺内(分期在p T2以内),2例(9.1%)累及前列腺外有/无精囊腺侵犯(即p T3);1例前列腺切缘阳性(4.5%)。前列腺标本规范化全部取材组的检出率高于部分取材组(21/45 vs.5/28 and46.7%vs.17.8%,P<0.05)。结论膀胱前列腺切除术后前列腺标本规范化取材有助于更多偶发前列腺癌被检出,因此推荐病理医师参考根治性前列腺癌标本处理原则,仔细并全面地对膀胱前列腺切除术后前列腺标本进行规范化取材。Objective We retrospectively reviewed data of patients with incidental prostate cancer（ PCa） that underwent radical cystoprostatectomy（ RCP） for bladder cancer to investigate their features with regard to clinicopathological characteristics,detection rate and how the standardized specimen handling of prostate influences the detection rate of PCa.Methods Seventy-three patients that underwent RCP for bladder cancer at our center between June 2005 and November2017 were collected. The pathological characteristics and detection rate of incidental prostate cancer were reviewed.Patients were divided into two groups： patients that had undergone the operation before and after 2011,when a policy of preferably complete prostate sampling in cystoprostatectomy specimens was introduced at our institution. Results 26 out of 73 patients（ 35. 6%） who underwent RCP had incidentally diagnosed as PCa. Most tumors were prostate acinar adenocarcinoma（ 84. 6%）; Gleason score was 6 or less（ grading group 1） in 16（ 72. 7%） cases,Gleason score was 3 ＋ 4= 7（ grading group 2） in 4（ 18. 2%） cases,Gleason score was 4 ＋ 3 = 7（ grading group 3） in 2（ 9. 1%） cases. Most tumors（ 20/22,90. 9%） were organ-confined（ pT2）,whereas 2（ 9. 1%） were p T3. Surgical margins was in 1（ 5. 4%）case. Cases processed after the 2011 recommended sampling changes had a significantly higher detection rate of incidental prostatic carcinoma and clinically significant prostatic carcinoma than the pre-2011 group. Conclusions The standardized specimen handling of prostate in cystoprostatectomy specimens results in a higher detection rate of incidental prostatic carcinoma than with partial processing. In conclusion,we believe that standardized specimen handling of prostate should be mandatory.

关 键 词：膀胱癌 膀胱前列腺切除术 前列腺癌 

分 类 号：R737.25[医药卫生—肿瘤]