Predictive factors of Gleason score upgrading in prostate cancer patients after radical prostatectomy

李海斌; 敬培胜

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Predictive factors of Gleason score upgrading in prostate cancer patients after radical prostatectomy

更新时间：2026-01-09

- Predictive factors of Gleason score upgrading in prostate cancer patients after radical prostatectomy
- Journal of Army Medical University Vol. 38, Issue 24, Pages: 2656-2660(2016)
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  CLC： R446.8;R730.7;R737.25
- Published：2016
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李海斌,敬培胜.前列腺癌患者根治术后病理Gleason评分升高预测因素研究[J].陆军军医大学学报(原第三军医大学学报),2016,38(24):2656-2660.

　Li Haibin,Jing Peisheng.Predictive factors of Gleason score upgrading in prostate cancer patients after radical prostatectomy[J].J Amry Med Univ (J Third Mil Med Univ),2016,38(24):2656-2660.
李海斌,敬培胜.前列腺癌患者根治术后病理Gleason评分升高预测因素研究[J].陆军军医大学学报(原第三军医大学学报),2016,38(24):2656-2660. DOI：

　Li Haibin,Jing Peisheng.Predictive factors of Gleason score upgrading in prostate cancer patients after radical prostatectomy[J].J Amry Med Univ (J Third Mil Med Univ),2016,38(24):2656-2660. DOI：

摘要

目的探讨经直肠前列腺穿刺活检的中低危前列腺癌患者术后发生病理Gleason评分升高的预测因素。方法收集2005年1月至2016年5月于我院泌尿外科接受前列腺穿刺活检并行前列腺癌根治手术的123例中低危前列腺癌患者的临床资料，回顾性分析术后发生Gleason评分升高与患者年龄、术前血清总前列腺特异抗原(total prostate specific antigen

tPSA）、术前血清游离PSA（fPSA）/tPSA、前列腺体积、前列腺特异性抗原密度（PSAD）、穿刺阳性针数比、切缘阳性率、穿刺评分等级、临床分期等的关系，进一步分析其预测价值。结果 123例患者中经直肠超声(transrectal ultrasonography，TRUS)引导下前列腺穿刺活检病理Gleason评分与前列腺癌根治术后病理Gleason评分保持一致66例（53.7%），评分下降10例（8.1%），评分升高47例（38.2%）。前列腺体积、PSAD及穿刺活检病理Gleason评分等级与术后发生病理Gleason评分升高有关（P0.05）。进一步Logistic回归分析结果显示仅PSAD（P=0.01）与穿刺活检病理Gleason评分等级（P=0.03）是前列腺癌根治术后病理Gleason评分升高的独立预测因子。应用受试者工作特征（receiver operating characteristic

ROC）曲线分析得出：前列腺穿刺活检病理Gleason评分等级=7的患者，PSAD＞0.282 ng/(mL·g)时，根治术后发生具有临床意义的Gleason评分升高的可能性大（敏感性78.2%，特异性70.4%）；而前列腺穿刺活检病理Gleason评分等级≤6的患者，PSAD＞0.265 ng/(mL·g)时，根治术后发生具有临床意义的Gleason评分升高的可能性大（敏感性77.1%，特异性68.0%）。结论 PSAD与穿刺评分等级是根治术后病理Gleason评分升高的独立预测因子。PSAD与前列腺癌患者术后发生病理Gleason评分升高密切相关。

Abstract

Objective To investigate the predictive factors of postoperative upgrading of Gleason score by assessment of discrepancy between preoperative biopsy Gleason score (bGS) and Gleason score after radical prostatectomy in the patients with prostate cancer. Methods This study comprised a retrospective analysis of 123 patients who underwent radical prostatectomy after diagnosed with low and intermediate risk prostate cancers proved by transrectal ultrasonography (TRUS)guided prostate biopsy in our hospital from January 2005 to May 2016. Correlation analysis was performed between postoperative upgraded Gleason score and preoperative parameters including age

total prostate specific antigen (tPSA) and ratio of free to total PSA (fPSA/tPSA)

prostate volume

prostate specific antigen density (PSAD)

ratio of positive to total number of biopsy cores taken

positive margin rate (%)

bGS and clinical stage. Results Sixty-six out of 123 patients (53.7%) had consistent Gleason score assessed by preoperative biopsy and postoperative radical prostatectomy. The Gleason score was downgraded in 10 patients (8.1%) and upgraded in 47 patients (38.2%) after radical prostatectomy. The prostate volume

PSAD and bGS were significantly correlated with the upgrading of Gleason score after operation (P0.05). However

only PSAD (P=0.01) and bGS (P=0.03) were independent predictors of Gleason score upgrading revealed by logistic regression analysis. Furthermore

analysis of receiver operating characteristic (ROC) curve showed that in the patients having bGS of 7 and PSAD0.282 ng/(mL·g）

the possibility of Gleason score upgrading was increased associated with clinical significance (sensitivity 78.2%

specificity 70.4%). Likewise

in the patients with bGS≤6 and PSAD0.265 ng/(mL·g）

clinically upgrading of Gleason score was strongly possible (sensitivity 77.1%

specificity 68.0%). Conclusion PSAD and bGS are independent predictors of Gleason score upgrading after radical prostatectomy. PSAD is closely related with upgrading of Gleason score after operation. Taking consideration of PSAD and biopsy Gleason score together may contribute to more accurate treatment decisions for patients with prostate cancer.

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