摘要:Gleason评分对于前列腺癌风险评估、治疗决策制定和预后判断有重要价值,而前列腺穿刺活检与根治性 前列腺切除术 (radical prostatectomy,RP) 后病理的 Gleason 评分常存在差异,且主要表现为评分升级,这 严重影响了临床决策的制定及预后判断。本文回顾近年国内外相关文献,对RP后Gleason评分升级相关因素的研 究进展作一综述,旨在为患者提供更加精准的风险评估和最佳的个体化治疗方案,最终改善患者预后,提高生存质量。
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GLOBOCAN 2020 数据显示,全球前列腺癌 (prostate cancer,PCa) 患病率居男性恶性肿瘤第 2 位,病死率居第 5位[1] 。与欧美发达地区相比,我国 前列腺癌患病率较低,但近年呈显著上升趋势。前 列腺穿刺活检是目前唯一能够获取前列腺癌确诊信 息的临床检测手段[2] ,穿刺病理提供的 Gleason 评分 对于疾病风险评估、治疗决策制定和判断预后有着 重要的意义。由于病理分级错误、肿瘤异质性或抽 样误差等原因,临床中前列腺穿刺活检与根治性前 列腺切除术后病理的 Gleason评分常存在差异,且主 要表现为评分升级。这不仅影响了诊治策略的选择, 且 Gleason 评分升级与根治性前列腺切除术 (radical prostatectomy,RP) 后手术切缘阳性、包膜外 或精囊侵犯、生化复发等不良预后相关[3] 。本文回顾 近年国内外相关文献,对根治性前列腺切除术后 Gleason评分升级相关因素的研究进展作一综述。
1 年龄、体质量指数 (body mass index,BMI) 对 Gleason 评分升级的影响
2 临床指标对 Gleason 评分升级的影响
2.1 前列腺特异性抗原
2.2 炎性细胞
3 穿刺相关因素对 Gleason 评分升级的影响
3.1 穿刺方式、穿刺至 RP 间隔时间
3.2 穿刺针数、穿刺阳性针数及穿刺阳性针数百分 比、肿瘤组织长度 (肿瘤百分比)、穿刺长度
4 前列腺影像报告和数据系统 (prostate imaging reporting and data system,PI-RADS) 对 Gleason 评分升级的影响
5 其他因素及预测模型建立
6 小结
6 小结
影响前列腺穿刺活检与 RP 后 Gleason评分升级 的因素众多,部分因素尚存在争议,各因素间可能 存在交互作用,一些潜在的可能有意义的因素尚未 被纳入研究,未来更多的大规模、多中心前瞻性研 究有望进一步阐明影响 Gleason 评分升级的预测因 素。临床上结合多项预测因素进行综合评估,能够 增加泌尿科医生在临床决策方面的信心,为前列腺 癌患者提供更加精确全面的风险评估及最佳的个体 化治疗方案,最终改善患者预后,提高生存质量。
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