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目的:探讨前列腺癌根治术后标本较前列腺穿刺活检标本Gleason评分升级的影响因素。方法:回顾性分析2012年1月至2015年6月接受前列腺穿刺活检确诊为前列腺癌并行根治性切除的235例患者年龄、术前PSA、前列腺体积、PSA密度(PSAD)、穿刺至手术间隔时间、穿刺阳性针数、切缘情况、精囊侵犯、淋巴转移等指标,统计其穿刺和术后Gleason评分的差异。运用Logistic回归分析引起术后Gleason评分升级的危险因素。结果:164例患者纳入分析,其中术前穿刺与根治术后标本Gleason评分相符有95例(57.93%),术后上升55例(33.54%),下降14例(8.52%)。前列腺体积(P<0.01)和穿刺评分(P<0.05)是影响根治术后标本Gleason评分升级的独立预测因子,其中前列腺体积≤25 ml组其术后Gleason评分升高的风险是体积>60 ml组的27倍(P<0.05),前列腺体积25~40 ml组术后Gleason评分升高的风险是体积>60 ml组的9倍(P<0.05)。结论:穿刺Gleason评分≤6、小体积前列腺(≤40 ml),术后Gleason评分升级可能性大。
Objective: To investigate the influencing factors of the Gleason score of prostatic cancer specimens after prostatectomy compared with prostatic biopsy specimens. Methods: The clinical data of 235 patients with prostate cancer undergoing radical prostatectomy undergoing prostate biopsy from January 2012 to June 2015 were retrospectively analyzed in terms of age, preoperative PSA, prostate volume, PSA density (PSAD), time between perforation and operation , The number of puncturing positive stitches, the margin of incision, the invasion of seminal vesicle and the lymphatic metastasis. The difference of the Gleason scores between the puncture and the postoperative Gleason score was calculated. Logistic regression analysis was used to analyze the risk factors for postoperative Gleason score escalation. Results: A total of 164 patients were included in the analysis. Among them, 95 cases (57.93%) were preoperatively treated with Gleason score and 55 cases (33.54%) postoperatively with 14 cases (8.52%) decreased. Prostate volume (P <0.01) and puncture score (P <0.05) were independent predictors of Gleason score increase after radical operation. The risk of postoperative Gleason score increased by prostate volume> 25 ml was> 60 ml (P <0.05), and the risk of postoperative Gleason score increased by 9 times (P <0.05) in the volume> 60 ml group in the prostate volume 25 ~ 40 ml group. Conclusion: Gleason score less than 6, small volume of prostate (≤ 40 ml), postoperative Gleason score upgrade possibility.