格里森得分3+4 (二级组) 样本检查和术后病理升级的前列腺癌:系统性审查和元分析
Shulin Wu1, Sharron X Lin2, Adam S Feldman2
1Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Clinical genitourinary cancer
|November 25, 2025
概括
前列腺癌3+4级针活检在23.4%的急性前列腺切除术中得到了升级. 关键预测因素包括年龄和PI-RADS,活检方法在升级率上没有显著差异.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 在瘤学瘤学.
- 病理学 病理学 病理学
背景情况:
- 积极监测是中等风险前列腺癌 (PCa) 患者的治疗选择.
- 针活检 (Bx) 3+4诊断的临床异质性为积极监测带来了不确定性.
- 在急性前列腺切除术 (RP) 中,Bx 3+4的升级是影响治疗决策的关键问题.
研究的目的:
- 为了研究从Bx 3+4的病理升级到不良的RP病理.
- 评估升级对瘤结果的影响.
- 为了确定Bx 3+4前列腺癌中升级的预测因素.
主要方法:
- 进行了系统的文献搜索,直到2025年2月.
- 对48项研究的数据进行了元分析,其中包括63,119名Bx 3+4和RP病理匹配的患者.
- 确定了升级的独立预测因素.
主要成果:
- Bx 3+4升级到RP ≥4+3的发生率为23.4%.
- 年龄,临床T阶段 (cT),PI-RADS,活检中癌症的最大百分比 (GPC) 和阳性核的数量是升级的重要预测因素.
- 在系统活检 (SBx) 和MRI向活检 (TBx) 方法之间,或在跨直肠 (TR) 和跨关节 (TP) 方法之间,没有观察到系统活检 (SBx) 和MRI向活检 (TBx) 方法之间的升级率的显著差异.
结论:
- 从Bx 3+4升级到不良的RP病理发生在23.4%的病例中.
- 患有升级疾病的患者可能会经历显著更差的生化无复发生存期.
- 活检方法不会显著影响从Bx 3+4升级到RP ≥4+3.3的升级率.
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