前列腺穿刺与前列腺癌根治术后Gleason评分的比较  

Comparative study of Gleason score between prostate biopsy and radical prostatectomy

作　　者：雷银 吴汶钊 李天杰 刘孝东[2] LEI Yin;WU Wenzhao;LI Tianjie;LIU Xiaodong(Department of Urology,First People's Hospital of Shuangliu District,Chengdu 610200,China;不详)

机构地区：[1]成都市双流区第一人民医院泌尿外科,610200 [2]昆明医科大学第一附属医院泌尿外科

出　　处：《现代泌尿生殖肿瘤杂志》2020年第6期338-342,共5页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的探讨腹腔镜下行前列腺癌根治术(RP)后Gleason评分与穿刺评分变化的危险因素。方法收集昆明医科大学第一附属医院泌尿外科2016年12月至2019年12月间110例行RP患者的临床资料,回顾性分析患者PI-RADS V2评分、年龄、前列腺特异性抗原(PSA)、穿刺阳性针数、前列腺体积(PV)、穿刺评分、手术切缘、TNM分期等指标与术前、术后病理Gleason评分变化的关系。结果本研究共纳入110例患者,术后Gleason评分升高36例(32.7%),术后Gleason评分降低15例(13.7%),术前、术后Gleason评分一致59例(53.6%)。多因素Logistic回归分析显示PV及术前穿刺Gleason评分(6分,≥7分)是腹腔镜下行RP后Gleason评分升高的独立危险因子,与RP后Gleason评分升高呈负相关,即PV越小,RP后Gleason评分升高可能性越大;术前穿刺Gleason评分6分出现RP后Gleason评分升高的可能性更大。结论对比前列腺穿刺Gleason评分,RP后存在Gleason评分升高的风险,并且在穿刺Gleason评分6分的患者中术后Gleason评分升高的发生率更高。对PV小的穿刺Gleason评分6分患者需要更加的警惕,避免病情的延误。Objective To explore the risk factors for the changes of Gleason score between prostate biopsy and radical prostatectomy.Methods The clinical data of patients who underwent radical prostatectomy in First Affiliated Hospital of Kunming Medical University from December 2016 to December 2019,including age,prostate-specific antigen,PSAD,prostate volume,PI-RADS V2 score,positive needle count,positive surgical margin,stage TNM,pathological outcome of prostate biopsy and pathological outcome of radical prostatectomy were collected.The correlation between the clinical data and the changes of Gleason score of pre-and post-operation was-analyzed.Results In all,110 patients were analyzed.After operation,36 patients(32.7%)had an upgrade in Gleason score,15 patients(13.7%)had a downgrade in Gleason score and 59 patients(53.6%)had stable Gleason score.Multivariate Logistic regression analysis showed that prostate volume(P<0.05)and Gleason score(P<0.01)were independent risk factors for Gleason score upgrading of post operation.The risk of postoperative Gleason score regrading was higher in the patients with smaller prostate volume and low Gleason score(6).Conclusions Compared with prostate biopsy,higher risk of Gleason score regrading can be found after radical prostatectomy,especially in patients with Gleason score of 6 in prostate biopsy.We should be alert to patients with small prostate volume and Gleason score of 6 in prostate biopsy to avoid delays in treatment.

关 键 词：GLEASON评分 前列腺体积 前列腺癌 PI-RADS V2 

分 类 号：R737.25[医药卫生—肿瘤]