To analyze the performance of the Prostate Health Index(phi)and its derivatives for predicting Gleason score(GS)upgrading between prostate biopsy and radical prostatectomy(RP)in the Chinese population,an observational...To analyze the performance of the Prostate Health Index(phi)and its derivatives for predicting Gleason score(GS)upgrading between prostate biopsy and radical prostatectomy(RP)in the Chinese population,an observational,prospective RP cohort consisting of 351 patients from two medical centers was established from January 2017 to September 2020.Pathological reclassification was determined by the Gleason Grade Group(GG).The area under the receiver operating characteristic curve(AUC)and logistic regression(LR)models were used to evaluate the predictive performance of predictors.In clinically low-risk patients with biopsy GG≤2,phi(odds ratio[OR]=1.80,95%confidence interval[95%CI]:1.14-2.82,P=0.01)and its derivative phi density(PHID;OR=2.34,95%CI:1.30-4.20,P=0.005)were significantly associated with upgrading to GG≥3 after RP,and the results were confirmed by multivariable analysis.Similar results were observed in patients with biopsy GG of 1 for the prediction of upgrading to RP GG≥2.Compared to the base model(AUC=0.59),addition of the phi or PHID could provide additional predictive value for GS upgrading in low-risk patients(AUC=0.69 and 0.71,respectively,both P<0.05).In conclusion,phi and PHID could predict GS upgrading after RP in clinically low-risk patients.展开更多
Eastern Cooperative Oncology Group(ECOG)performance status and Gleason score are commonly investigated factors for overall survival(OS)in men with castration-resistant prostate cancer(CRPC).However,there is a lack of ...Eastern Cooperative Oncology Group(ECOG)performance status and Gleason score are commonly investigated factors for overall survival(OS)in men with castration-resistant prostate cancer(CRPC).However,there is a lack of consistency regarding their prognostic or predictive value for OS.Therefore,we performed this meta-analysis to assess the associations of ECOG performance status and Gleason score with OS in CRPC patients and compare the two markers in patients under different treatment regimens or with different chemotherapy histories.A systematic literature review of monotherapy studies in CRPC patients was conducted in the PubMed database until May 2019.The data from 8247 patients in 34 studies,including clinical trials and real-world data,were included in our meta-analysis.Of these,twenty studies reported multivariate results and were included in our main analysis.CRPC patients with higher ECOG performance statuses(≥2)had a significantly increased mortality risk than those with lower ECOG performance statuses(<2),hazard ratio(HR):2.10,95%confidence interval(CI):1.68-2.62,and P<0.001.The synthesized HR of OS stratified by Gleason score was 1.01,with a 95%CI of 0.62-1.67(Gleason score≥8 vs<8).Subgroup analysis showed that there was no significant difference in pooled HRs for patients administered taxane chemotherapy(docetaxel and cabazitaxel)and androgen-targeting therapy(abiraterone acetate and enzalutamide)or for patients with different chemotherapy histories.ECOG performance status was identified as a significant prognostic factor in CRPC patients,while Gleason score showed a weak prognostic value for OS based on the available data in our meta-analysis.展开更多
We aimed to compare Gleason score and tumor laterality between transrectal ultrasound-guided biopsy of the prostate （TRUSBX） and radical prostatectomy （RP）. Some factors that could cause a discrepancy in results b...We aimed to compare Gleason score and tumor laterality between transrectal ultrasound-guided biopsy of the prostate （TRUSBX） and radical prostatectomy （RP）. Some factors that could cause a discrepancy in results between these two procedures were also evaluated. Among the 318 cases reviewed, 191 cases were selected for inclusion in this comparative Study, We divided the patients into two groups using the Gleason score： an intermediate/high-grade group （≥7） and a low-grade group （〈6）. Exploratory analyses were conducted for comparisons between groups. We also performed comparisons between TRUSBX and RP for tumor laterality. TRUSBX overestimated 6% and underestimated 24% cases in comparison with RP for Gleason score, and overestimated 2.6% and underestimated 46% cases compared with RP for tumor laterality. Biopsy specimens were slightly smaller in TRUSBX cases with underestimated tumor laterality （P〈 0.05）, and no relationship between the biopsy specimen size and underestimated Gleason score in TRUSBX was found. Prostatic volume showed no statistical correlation with the likelihood of under or overestimation （P 〉 0.05）. Thus, our study showed that TRUSBX has a high likelihood of underestimating both the Gleason score and tumor laterality in prostate cancer （PCa）. The size of the fragment appears to be an important factor influencing the likelihood of laterality underestimation and Gleason score overestimation via TRUSBX. Due to the high likelihood of underestimation of the Gleason score and tumor laterality by 12-core prostate biopsy, we conclude that this type of biopsy should not be used alone to guide therapy in Pca.展开更多
目的研究前列腺癌磁共振扩散张量成像(DTI)参数表观扩散系数(ADC)与各向异性分数(FA)与其病理分级(Gleason评分)的关系,评价ADC值与FA值对于前列腺癌病理分级的诊断价值及评价前列腺癌危险度分级的诊断效能。方法采用3.0 T MR对70例经...目的研究前列腺癌磁共振扩散张量成像(DTI)参数表观扩散系数(ADC)与各向异性分数(FA)与其病理分级(Gleason评分)的关系,评价ADC值与FA值对于前列腺癌病理分级的诊断价值及评价前列腺癌危险度分级的诊断效能。方法采用3.0 T MR对70例经病理证实的前列腺癌患者行DTI检查,b值为0和800 s/mm2。测量前列腺癌的ADC值及FA值,根据病理结果将患者按Gleason评分系统分为高、中、低危三组:Gleason≥8分、Gleason=7分、Gleason≤6分。对三组数据进行单因素方差分析(one-way ANOVA),并进行组间两两比较。采用Pearson相关分析检验前列腺癌ADC值及FA值与Gleason评分的相关性。将前列腺癌Gleason评分≤7与Gleason评分≥8两组之间进行受试者工作特性(ROC)曲线分析,判断低中危组与高危组诊断界值。结果三组前列腺癌区平均ADC值分别为(0.96±0.10)×10-3mm2/s、(0.76±0.15)×10-3mm2/s和(0.62±0.12)×10-3mm2/s,FA值分别为0.39±0.06、0.31±0.09和0.22±0.06;三组ADC值、FA值组间差异均具有统计学意义(P<0.05);ADC值、FA值与Gleason评分之间均呈负相关(ADC值r=-0.768,P<0.05;FA值r=-0.662,P<0.05),两者均随Gleason评分的增高而减小。以ADC=0.68×10-3mm2/s为临界点,区分低中危组与高危组癌灶的诊断敏感性84.2%,特异性76.9%,准确性87.1%;以FA=0.24为临界点,区分低中危组与高危组癌灶的诊断敏感性79.5%,特异性75.8%,准确性78.4%。结论前列腺癌ADC值及FA值与病理分级(Gleason评分)之间呈负相关,具有预测癌灶恶性程度的潜力,有助于预测前列腺癌的恶性程度。展开更多
目的研究中央腺前列腺癌灶和膀胱内尿液表观扩散系数比值(rADC)与Gleason评分的关系,评价ADC值在中央腺前列腺癌Gleason分级中的诊断价值。资料与方法使用1.5 T MR扫描仪对69例经根治术或穿刺活检病理证实的前列腺癌患者进行扩散加权成...目的研究中央腺前列腺癌灶和膀胱内尿液表观扩散系数比值(rADC)与Gleason评分的关系,评价ADC值在中央腺前列腺癌Gleason分级中的诊断价值。资料与方法使用1.5 T MR扫描仪对69例经根治术或穿刺活检病理证实的前列腺癌患者进行扩散加权成像(DWI)检查,b值取0和800 s/mm2,分别测量中央腺癌灶和膀胱内尿液相对ADC值,计算中央腺前列腺癌的rADC;根据病理结果将中央腺前列腺癌分为Gleason 3+3,3+4,4+3,≥4+4四组,将各组中央腺前列腺癌rADC与Gleason评分进行单因素方差分析(one-way ANOVA),并进行组间两两比较。采用Pearson相关分析检验中央腺前列腺癌rADC与Gleason评分的相关性。将中央腺前列腺癌Gleason评分≤7与Gleason评分≥8两组之间分别进行受试者工作特性(ROC)曲线分析,判断低中危组与高危组诊断界值点。结果中央腺前列腺癌Gleason评分3+3组与其余各组间rADC差异均有统计学意义(P<0.05),3+4,4+3、≥4+4各组间rADC差异无统计学意义(P>0.05)。中央腺前列腺癌rADC与Gleason评分呈负相关(相关系数r=-0.58,P<0.01;),Gleason评分越高,rADC越小。以rADC值0.225作为阈值,鉴别低中危组与高危组中央腺前列腺癌的敏感度和特异度分别为71.4%和85%。结论中央腺前列腺癌ADC值与Gleason评分有一定相关性,有助于中央腺前列腺癌临床危险度的分级判定。展开更多
背景与目的:前列腺癌穿刺标本的Gleason评分是术前进行预后判断及制定治疗方案的重要参考之一,其准确性直接影响对预后的评价及具体治疗措施的选择。本研究主要探讨前列腺癌穿刺标本与根治标本Gleason评分的差异,分析影响穿刺标本Gleaso...背景与目的:前列腺癌穿刺标本的Gleason评分是术前进行预后判断及制定治疗方案的重要参考之一,其准确性直接影响对预后的评价及具体治疗措施的选择。本研究主要探讨前列腺癌穿刺标本与根治标本Gleason评分的差异,分析影响穿刺标本Gleason评分准确性的可能因素。方法:收集穿刺活检证实为前列腺癌并接受根治术的前列腺癌患者126例,采用新Gleason分级评分标准对穿刺和根治标本进行重新评分,并采用Kappa一致性检验及配对卡方检验,对两者的Gleason评分进行比较,对可能影响两者符合率的因素进行二分类Logistic回归分析。结果:126例患者中穿刺标本的Gleason评分与根治标本71例(56.3%)一致,17例(13.5%)偏高,38例(30.2%)偏低,差异具有统计学意义(P<0.05)。将两者评分划分为不同的预后组,差异仍具有统计学意义(P<0.05)。偏差与年龄、术前前列腺特异抗原(prostate specific antigen,PSA)水平、前列腺体积、临床分期及每针最大癌累及无显著相关性(P>0.05),而与穿刺阳性针数百分比显著相关(OR=2.482,P<0.05)。结论:穿刺标本与根治标本的Gleason评分一致性一般,多数情况穿刺标本评分偏低,少数评分偏高;穿刺的阳性针数百分比是影响评分准确性的可能因素。展开更多
基金supported by grants from the National Natural Science Foundation of China(No.81772741 and No.81972645),Shanghai Jiao Tong University School of Medicine Gaofeng-Clinical Medicine Grant Support(No.20181701)Shanghai Municipal Human Resources and Social Security Bureau(No.2018052)to RNthe Clinical Research Project of Shanghai Health Commission(No.20214Y0511)to YSW.
文摘To analyze the performance of the Prostate Health Index(phi)and its derivatives for predicting Gleason score(GS)upgrading between prostate biopsy and radical prostatectomy(RP)in the Chinese population,an observational,prospective RP cohort consisting of 351 patients from two medical centers was established from January 2017 to September 2020.Pathological reclassification was determined by the Gleason Grade Group(GG).The area under the receiver operating characteristic curve(AUC)and logistic regression(LR)models were used to evaluate the predictive performance of predictors.In clinically low-risk patients with biopsy GG≤2,phi(odds ratio[OR]=1.80,95%confidence interval[95%CI]:1.14-2.82,P=0.01)and its derivative phi density(PHID;OR=2.34,95%CI:1.30-4.20,P=0.005)were significantly associated with upgrading to GG≥3 after RP,and the results were confirmed by multivariable analysis.Similar results were observed in patients with biopsy GG of 1 for the prediction of upgrading to RP GG≥2.Compared to the base model(AUC=0.59),addition of the phi or PHID could provide additional predictive value for GS upgrading in low-risk patients(AUC=0.69 and 0.71,respectively,both P<0.05).In conclusion,phi and PHID could predict GS upgrading after RP in clinically low-risk patients.
文摘Eastern Cooperative Oncology Group(ECOG)performance status and Gleason score are commonly investigated factors for overall survival(OS)in men with castration-resistant prostate cancer(CRPC).However,there is a lack of consistency regarding their prognostic or predictive value for OS.Therefore,we performed this meta-analysis to assess the associations of ECOG performance status and Gleason score with OS in CRPC patients and compare the two markers in patients under different treatment regimens or with different chemotherapy histories.A systematic literature review of monotherapy studies in CRPC patients was conducted in the PubMed database until May 2019.The data from 8247 patients in 34 studies,including clinical trials and real-world data,were included in our meta-analysis.Of these,twenty studies reported multivariate results and were included in our main analysis.CRPC patients with higher ECOG performance statuses(≥2)had a significantly increased mortality risk than those with lower ECOG performance statuses(<2),hazard ratio(HR):2.10,95%confidence interval(CI):1.68-2.62,and P<0.001.The synthesized HR of OS stratified by Gleason score was 1.01,with a 95%CI of 0.62-1.67(Gleason score≥8 vs<8).Subgroup analysis showed that there was no significant difference in pooled HRs for patients administered taxane chemotherapy(docetaxel and cabazitaxel)and androgen-targeting therapy(abiraterone acetate and enzalutamide)or for patients with different chemotherapy histories.ECOG performance status was identified as a significant prognostic factor in CRPC patients,while Gleason score showed a weak prognostic value for OS based on the available data in our meta-analysis.
文摘We aimed to compare Gleason score and tumor laterality between transrectal ultrasound-guided biopsy of the prostate （TRUSBX） and radical prostatectomy （RP）. Some factors that could cause a discrepancy in results between these two procedures were also evaluated. Among the 318 cases reviewed, 191 cases were selected for inclusion in this comparative Study, We divided the patients into two groups using the Gleason score： an intermediate/high-grade group （≥7） and a low-grade group （〈6）. Exploratory analyses were conducted for comparisons between groups. We also performed comparisons between TRUSBX and RP for tumor laterality. TRUSBX overestimated 6% and underestimated 24% cases in comparison with RP for Gleason score, and overestimated 2.6% and underestimated 46% cases compared with RP for tumor laterality. Biopsy specimens were slightly smaller in TRUSBX cases with underestimated tumor laterality （P〈 0.05）, and no relationship between the biopsy specimen size and underestimated Gleason score in TRUSBX was found. Prostatic volume showed no statistical correlation with the likelihood of under or overestimation （P 〉 0.05）. Thus, our study showed that TRUSBX has a high likelihood of underestimating both the Gleason score and tumor laterality in prostate cancer （PCa）. The size of the fragment appears to be an important factor influencing the likelihood of laterality underestimation and Gleason score overestimation via TRUSBX. Due to the high likelihood of underestimation of the Gleason score and tumor laterality by 12-core prostate biopsy, we conclude that this type of biopsy should not be used alone to guide therapy in Pca.
文摘目的研究前列腺癌磁共振扩散张量成像(DTI)参数表观扩散系数(ADC)与各向异性分数(FA)与其病理分级(Gleason评分)的关系,评价ADC值与FA值对于前列腺癌病理分级的诊断价值及评价前列腺癌危险度分级的诊断效能。方法采用3.0 T MR对70例经病理证实的前列腺癌患者行DTI检查,b值为0和800 s/mm2。测量前列腺癌的ADC值及FA值,根据病理结果将患者按Gleason评分系统分为高、中、低危三组:Gleason≥8分、Gleason=7分、Gleason≤6分。对三组数据进行单因素方差分析(one-way ANOVA),并进行组间两两比较。采用Pearson相关分析检验前列腺癌ADC值及FA值与Gleason评分的相关性。将前列腺癌Gleason评分≤7与Gleason评分≥8两组之间进行受试者工作特性(ROC)曲线分析,判断低中危组与高危组诊断界值。结果三组前列腺癌区平均ADC值分别为(0.96±0.10)×10-3mm2/s、(0.76±0.15)×10-3mm2/s和(0.62±0.12)×10-3mm2/s,FA值分别为0.39±0.06、0.31±0.09和0.22±0.06;三组ADC值、FA值组间差异均具有统计学意义(P<0.05);ADC值、FA值与Gleason评分之间均呈负相关(ADC值r=-0.768,P<0.05;FA值r=-0.662,P<0.05),两者均随Gleason评分的增高而减小。以ADC=0.68×10-3mm2/s为临界点,区分低中危组与高危组癌灶的诊断敏感性84.2%,特异性76.9%,准确性87.1%;以FA=0.24为临界点,区分低中危组与高危组癌灶的诊断敏感性79.5%,特异性75.8%,准确性78.4%。结论前列腺癌ADC值及FA值与病理分级(Gleason评分)之间呈负相关,具有预测癌灶恶性程度的潜力,有助于预测前列腺癌的恶性程度。
文摘背景与目的:前列腺癌穿刺标本的Gleason评分是术前进行预后判断及制定治疗方案的重要参考之一,其准确性直接影响对预后的评价及具体治疗措施的选择。本研究主要探讨前列腺癌穿刺标本与根治标本Gleason评分的差异,分析影响穿刺标本Gleason评分准确性的可能因素。方法:收集穿刺活检证实为前列腺癌并接受根治术的前列腺癌患者126例,采用新Gleason分级评分标准对穿刺和根治标本进行重新评分,并采用Kappa一致性检验及配对卡方检验,对两者的Gleason评分进行比较,对可能影响两者符合率的因素进行二分类Logistic回归分析。结果:126例患者中穿刺标本的Gleason评分与根治标本71例(56.3%)一致,17例(13.5%)偏高,38例(30.2%)偏低,差异具有统计学意义(P<0.05)。将两者评分划分为不同的预后组,差异仍具有统计学意义(P<0.05)。偏差与年龄、术前前列腺特异抗原(prostate specific antigen,PSA)水平、前列腺体积、临床分期及每针最大癌累及无显著相关性(P>0.05),而与穿刺阳性针数百分比显著相关(OR=2.482,P<0.05)。结论:穿刺标本与根治标本的Gleason评分一致性一般,多数情况穿刺标本评分偏低,少数评分偏高;穿刺的阳性针数百分比是影响评分准确性的可能因素。
