Abstract：
BACKGROUND: Thanks to technological advances, prostate cancer (PCa) can be diagnosed at a younger age. It is known that most of these patients are in the low-intermediate risk group, and the histological grade of the tumor increases in half of those undergoing radical prostatectomy (Rp) compared to their diagnostic biopsies. This is especially important in terms of active surveillance (AS) and/or the timely evaluation of curative treatment options in patients diagnosed at an early age. Our aim was to investigate clinical and histopathological parameters that may be associated with an increase in the histological grade of the tumor in patients with acinar adenocarcinoma who were diagnosed by transrectal ultrasound-guided biopsy (TRUS-Bx) and underwent Rp.
METHODS: A total of 205 patients with classical acinar adenocarcinoma diagnosed by TRUS-Bx without metastasis and who underwent Rp were grouped according to the D\'Amico risk classification. Age at diagnosis, serum prostate-specific antigen (PSA), PSA density, prostate volume, Prostate Imaging Reporting and Data System (PI-RADS) score, clinical stage, Gleason Grade Group (GGG), high-grade intraepithelial neoplasia in tumor-free cores (HGPIN) (single and ≥2 cores), perineural invasion (PNI), and lymphovascular invasion (LVI) was obtained. Additionally, GGG, pathological stage, lymph node metastasis, surgical margin positivity, and tumor volume obtained from Rp were evaluated. Comparisons were made between the case groups in which the tumor grade increased and remained the same, in terms of age, serum PSA, PSA density, HGPIN in tumor-free cores (single and ≥2 cores), PNI, and LVI in all biopsies (with or without tumors), as well as risk groups. In addition, the relationships of HGPIN in tumor-free cores (single and ≥2 cores), PNI, and LVI on TRUS-Bx with age, serum PSA and PSA density, tumor volume, surgical margin positivity, pathological stage, lymph node metastasis, and risk groups were examined separately.
RESULTS: Of the patients, 72 (35.1%) were in the low-risk group, 95 (46.3%) in the intermediate-risk group, and 38 (18.5%) in the high-risk group. Most of the patients with an increased histological grade (n = 38, 48.1%) were in the low-risk group (p < 0.05) and had an advanced median age. HGPIN in single and ≥2 tumor-free cores and PNI were more common in these patients (p < 0.01, p < 0.001, and p < 0.05, respectively). According to the multivariable analysis, advanced age (odds ratio [OR]: 1.087, 95% confidence interval [CI]: 1.029-1.148, p < 0.05), high serum PSA (OR: 1.047, 95% CI: 1.006-1.090, p < 0.05), HGPIN in ≥2 tumor-free cores (OR: 6.346, 95% CI: 3.136-12.912, p < 0.001), and PNI (OR: 3.138, 95% CI: 1.179-8.356, p < 0.05) were independent risk factors for a tumor upgrade. Furthermore, being in the low-risk group was an independent risk factor when compared to the intermediate- and high-risk groups (OR: 0.187, 95% CI: 0.080-0.437, p < 0.001 and OR: 0.054, 95% CI: 0.013-0.230, p < 0.001, respectively). The HGPIN diagnosis was more common in the low- and intermediate-risk groups. Advanced age at diagnosis, high serum PSA and PSA density values were associated with PNI on TRUS-Bx. High serum PSA and PSA density values were associated with LVI on TRUS-Bx. Surgical margin positivity was higher in cases with PNI and LVI detected by TRUS-Bx. HGPIN in ≥2 tumor-free cores, PNI, and LVI on TRUS-Bx were associated with a higher rate of lymph node metastases.
CONCLUSIONS: In patients diagnosed with acinar adenocarcinoma, the presence of HGPIN even in a single tumor-free core on TRUS-Bx was found to be significant in terms of showing an increase in the histological tumor grade in Rp. The diagnosis of HGPIN in ≥2 tumor-free cores on TRUS-Bx was determined as an independent risk factor for an increased Gleason score after Rp. Furthermore, an advanced age, a high serum PSA value, being in the low-risk group, and the presence of PNI were associated with a tumor upgrade. HGPIN in ≥2 tumor-free cores, PNI, and LVI were also associated with lymph node metastasis. Therefore, the diagnosis of HGPIN should be signed out on pathological reports.
METHODS: A total of 205 patients with classical acinar adenocarcinoma diagnosed by TRUS-Bx without metastasis and who underwent Rp were grouped according to the D\'Amico risk classification. Age at diagnosis, serum prostate-specific antigen (PSA), PSA density, prostate volume, Prostate Imaging Reporting and Data System (PI-RADS) score, clinical stage, Gleason Grade Group (GGG), high-grade intraepithelial neoplasia in tumor-free cores (HGPIN) (single and ≥2 cores), perineural invasion (PNI), and lymphovascular invasion (LVI) was obtained. Additionally, GGG, pathological stage, lymph node metastasis, surgical margin positivity, and tumor volume obtained from Rp were evaluated. Comparisons were made between the case groups in which the tumor grade increased and remained the same, in terms of age, serum PSA, PSA density, HGPIN in tumor-free cores (single and ≥2 cores), PNI, and LVI in all biopsies (with or without tumors), as well as risk groups. In addition, the relationships of HGPIN in tumor-free cores (single and ≥2 cores), PNI, and LVI on TRUS-Bx with age, serum PSA and PSA density, tumor volume, surgical margin positivity, pathological stage, lymph node metastasis, and risk groups were examined separately.
RESULTS: Of the patients, 72 (35.1%) were in the low-risk group, 95 (46.3%) in the intermediate-risk group, and 38 (18.5%) in the high-risk group. Most of the patients with an increased histological grade (n = 38, 48.1%) were in the low-risk group (p < 0.05) and had an advanced median age. HGPIN in single and ≥2 tumor-free cores and PNI were more common in these patients (p < 0.01, p < 0.001, and p < 0.05, respectively). According to the multivariable analysis, advanced age (odds ratio [OR]: 1.087, 95% confidence interval [CI]: 1.029-1.148, p < 0.05), high serum PSA (OR: 1.047, 95% CI: 1.006-1.090, p < 0.05), HGPIN in ≥2 tumor-free cores (OR: 6.346, 95% CI: 3.136-12.912, p < 0.001), and PNI (OR: 3.138, 95% CI: 1.179-8.356, p < 0.05) were independent risk factors for a tumor upgrade. Furthermore, being in the low-risk group was an independent risk factor when compared to the intermediate- and high-risk groups (OR: 0.187, 95% CI: 0.080-0.437, p < 0.001 and OR: 0.054, 95% CI: 0.013-0.230, p < 0.001, respectively). The HGPIN diagnosis was more common in the low- and intermediate-risk groups. Advanced age at diagnosis, high serum PSA and PSA density values were associated with PNI on TRUS-Bx. High serum PSA and PSA density values were associated with LVI on TRUS-Bx. Surgical margin positivity was higher in cases with PNI and LVI detected by TRUS-Bx. HGPIN in ≥2 tumor-free cores, PNI, and LVI on TRUS-Bx were associated with a higher rate of lymph node metastases.
CONCLUSIONS: In patients diagnosed with acinar adenocarcinoma, the presence of HGPIN even in a single tumor-free core on TRUS-Bx was found to be significant in terms of showing an increase in the histological tumor grade in Rp. The diagnosis of HGPIN in ≥2 tumor-free cores on TRUS-Bx was determined as an independent risk factor for an increased Gleason score after Rp. Furthermore, an advanced age, a high serum PSA value, being in the low-risk group, and the presence of PNI were associated with a tumor upgrade. HGPIN in ≥2 tumor-free cores, PNI, and LVI were also associated with lymph node metastasis. Therefore, the diagnosis of HGPIN should be signed out on pathological reports.
摘要：
背景：由于技术进步，前列腺癌（PCa）可以在更年轻的年龄被诊断出来。众所周知，这些患者中的大多数属于低-中等风险组，与诊断性活检相比，接受根治性前列腺切除术（Rp）的患者的肿瘤组织学分级增加了一半。这在主动监测（AS）和/或及时评估早期诊断的患者的治愈性治疗选择方面尤为重要。我们的目的是研究经直肠超声引导活检（TRUS-Bx）诊断并接受Rp的腺泡腺癌患者的临床和组织病理学参数，这些参数可能与肿瘤的组织学分级增加有关。
方法：将205例经TRUS-Bx诊断为无转移且接受Rp的典型腺泡腺癌患者按照D\'Amico风险分类进行分组。诊断时的年龄，血清前列腺特异性抗原（PSA），PSA密度,前列腺体积,前列腺影像报告和数据系统（PI-RADS）评分，临床分期,格里森等级组（GGG），无瘤核的高级别上皮内瘤变（HGPIN）（单个和≥2个核），神经周浸润（PNI），并获得淋巴管浸润（LVI）。此外,GGG,病理阶段,淋巴结转移,手术切缘阳性，评估从Rp获得的肿瘤体积。对肿瘤分级升高并保持不变的病例组进行比较,就年龄而言,血清PSA,PSA密度,无肿瘤核心中的HGPIN（单个和≥2个核心），PNI,和LVI在所有活检（有或没有肿瘤），以及风险群体。此外,HGPIN在无瘤核(单核和≥2核)中的关系，PNI,随着年龄的增长，TRUS-Bx上的LVI，血清PSA和PSA密度，肿瘤体积,手术切缘阳性，病理阶段,淋巴结转移,和风险组分别进行检查。
结果：在患者中，72（35.1％）在低风险组中，中等风险组95％（46.3％），高危人群中38人(18.5%)。大多数组织学分级升高的患者（n=38，48.1％）属于低风险组（p<0.05），中位年龄较高。单个和≥2个无瘤核的HGPIN和PNI在这些患者中更为常见（分别为p<0.01，p<0.001和p<0.05）。根据多变量分析，高龄(优势比[OR]：1.087，95%置信区间[CI]：1.029-1.148，p<0.05)，高血清PSA（OR：1.047，95%CI：1.006-1.090，p<0.05），HGPIN在≥2个无瘤核心中（OR：6.346，95％CI：3.136-12.912，p<0.001），PNI（OR：3.138，95％CI：1.179-8.356，p<0.05）是肿瘤升级的独立危险因素。此外，与中危组和高危组相比，低危组是一个独立的危险因素(OR:0.187,95%CI:0.080-0.437,p<0.001和OR:0.054,95%CI:0.013-0.230,p<0.001)。HGPIN诊断在低风险和中风险组中更为常见。诊断时高龄，高血清PSA和PSA密度值与TRUS-Bx上的PNI相关.高血清PSA和PSA密度值与TRUS-Bx上的LVI相关。TRUS-Bx检测到PNI和LVI的手术切缘阳性率更高。HGPIN在≥2个无瘤核心中，PNI,TRUS-Bx上的LVI与较高的淋巴结转移率相关。
结论：在诊断为腺泡腺癌的患者中，发现即使在TRUS-Bx上的单个无肿瘤核心中也存在HGPIN，这表明Rp的组织学肿瘤分级增加。在TRUS-Bx上≥2个无瘤核心中HGPIN的诊断被确定为Rp后Gleason评分增加的独立危险因素。此外，高龄,高血清PSA值,属于低风险组，PNI的存在与肿瘤升级相关.HGPIN在≥2个无瘤核心中，PNI,LVI也与淋巴结转移有关。因此,HGPIN的诊断应在病理报告上签字。
方法：将205例经TRUS-Bx诊断为无转移且接受Rp的典型腺泡腺癌患者按照D\'Amico风险分类进行分组。诊断时的年龄，血清前列腺特异性抗原（PSA），PSA密度,前列腺体积,前列腺影像报告和数据系统（PI-RADS）评分，临床分期,格里森等级组（GGG），无瘤核的高级别上皮内瘤变（HGPIN）（单个和≥2个核），神经周浸润（PNI），并获得淋巴管浸润（LVI）。此外,GGG,病理阶段,淋巴结转移,手术切缘阳性，评估从Rp获得的肿瘤体积。对肿瘤分级升高并保持不变的病例组进行比较,就年龄而言,血清PSA,PSA密度,无肿瘤核心中的HGPIN（单个和≥2个核心），PNI,和LVI在所有活检（有或没有肿瘤），以及风险群体。此外,HGPIN在无瘤核(单核和≥2核)中的关系，PNI,随着年龄的增长，TRUS-Bx上的LVI，血清PSA和PSA密度，肿瘤体积,手术切缘阳性，病理阶段,淋巴结转移,和风险组分别进行检查。
结果：在患者中，72（35.1％）在低风险组中，中等风险组95％（46.3％），高危人群中38人(18.5%)。大多数组织学分级升高的患者（n=38，48.1％）属于低风险组（p<0.05），中位年龄较高。单个和≥2个无瘤核的HGPIN和PNI在这些患者中更为常见（分别为p<0.01，p<0.001和p<0.05）。根据多变量分析，高龄(优势比[OR]：1.087，95%置信区间[CI]：1.029-1.148，p<0.05)，高血清PSA（OR：1.047，95%CI：1.006-1.090，p<0.05），HGPIN在≥2个无瘤核心中（OR：6.346，95％CI：3.136-12.912，p<0.001），PNI（OR：3.138，95％CI：1.179-8.356，p<0.05）是肿瘤升级的独立危险因素。此外，与中危组和高危组相比，低危组是一个独立的危险因素(OR:0.187,95%CI:0.080-0.437,p<0.001和OR:0.054,95%CI:0.013-0.230,p<0.001)。HGPIN诊断在低风险和中风险组中更为常见。诊断时高龄，高血清PSA和PSA密度值与TRUS-Bx上的PNI相关.高血清PSA和PSA密度值与TRUS-Bx上的LVI相关。TRUS-Bx检测到PNI和LVI的手术切缘阳性率更高。HGPIN在≥2个无瘤核心中，PNI,TRUS-Bx上的LVI与较高的淋巴结转移率相关。
结论：在诊断为腺泡腺癌的患者中，发现即使在TRUS-Bx上的单个无肿瘤核心中也存在HGPIN，这表明Rp的组织学肿瘤分级增加。在TRUS-Bx上≥2个无瘤核心中HGPIN的诊断被确定为Rp后Gleason评分增加的独立危险因素。此外，高龄,高血清PSA值,属于低风险组，PNI的存在与肿瘤升级相关.HGPIN在≥2个无瘤核心中，PNI,LVI也与淋巴结转移有关。因此,HGPIN的诊断应在病理报告上签字。
