少针阳性前列腺穿刺活检的临床病理意义  

Clinicopathological implications of prostate cancer with fewer positive cores at biopsy

作　　者：黄超[1] 刘正升[1] 王涛[1] 王雪刚[1] 李伟[1] 张开颜[1] 吴准[1] 邢金春[1] HUANG Chao;LIU Zhengsheng;WANG Tao;WANG Xuegang;LI Wei;ZHANG Kaiyan;WU Zhun;XING Jinchun(Department of Urology, First Affiliated Hospital of Xiamen University, Xiamen 361003, China)

机构地区：[1]厦门大学附属第一医院泌尿外科,361003

出　　处：《现代泌尿生殖肿瘤杂志》2021年第6期349-352,358,共5页Journal of Contemporary Urologic and Reproductive Oncology

基　　金：厦门市科技计划项目(3502Z20184014)。

摘　　要：目的通过回顾性分析前列腺穿刺活检1~3针阳性并行前列腺癌根治术患者的临床病理资料,了解少针阳性前列腺穿刺结果的临床病理意义。方法对58例前列腺穿刺活检阳性针数在1~3针并行前列腺癌根治术患者的临床病理资料进行对比分析,评价不同阳性针数的活检结果与根治术后病理分级的一致性,探索可能提示病理分级被低估的危险因素。结果穿刺结果与根治术后病理分级的差异有统计学意义(P<0.01),43.1%的病例发生病理分级升高,不论是单针或2针阳性病例,这一风险均没有减少。多因素回归分析显示,穿刺样本肿瘤组织百分比(P<0.05)可预测术后病理分级升高,穿刺样本肿瘤组织百分比为25%时预测价值较高。年龄、术前PSA、PSA密度、前列腺体积、MRI结果及穿刺针数均与病理分级升高无显著关联。结论对于穿刺活检1~3针阳性的前列腺癌,存在较大低估病理分级风险,术前可以结合穿刺样本肿瘤组织百分比进行预判。目前尚不能准确预判穿刺少针阳性前列腺癌的病理分级及指导治疗。Objective To understand the clinicopathological implications of prostate biopsy results with fewer positive cores by retrospectively analyzing the data of patients with 1-3 positive cores at prostate biopsy and subsequent radical prostatectomy.Methods The clinical and pathological data of 58 patients enrolled were analyzed and compared to evaluate the consistency of pathological grade between biopsy results with different positive cores and radical prostatectomy,and explore the possible risk factors that may indicate underestimation of pathologic grade.Results There was statistically significant difference between biopsy result and radical resection in pathological grade(P<0.01).Postoperative pathological grade was elevated in 43.1%of cases and the risk was not reduced for both single or two positive cores.Multivariate regression analysis showed that the percentage of tumor in positive cores had significance in predicting the postoperative pathological upgrade.The predictive power was optimum when the percentage of tumor in positive cores was 25%.Age,preoperative prostate-specific antigen(PSA),PSA density,prostate volume,MRI result or needle number were not significantly associated with the postoperative pathological upgrade.Conclusions For prostate cancer with 1-3 positive cores at biopsy,the risk of pathological grading is greatly underestimated.Preoperative prediction can be made based on the percentage of tumor in biopsy cores.At present,it is not able to accurately evaluate the pathological grade of the prostate cancer with fewer positive cores and guide the treatment.

关 键 词：前列腺肿瘤 活组织检查 针吸 病理学 临床 

分 类 号：R73[医药卫生—肿瘤]