전립선암의 병리학적 병기 예측인자에 대한 고찰
Role of clinical Stage, PSA and Gleason's Score in Predicting Pathologic Outcome in Prostate Cancer
소속 상세정보
안한종/Hanjong Ahn
최은호/김정균/홍범식/정태규/박형근/김청수/박태한/공경엽/Eun Ho Ch oi/Jung Gyun Kim/Beom Sik Hong/Taegyu Chung/Hyungkeun Park/Choung-Soo Kim/Taehan Park/Gyungyub Gong
KMID : 0358319970380121318
Abstract
결론
근치적 전립선적출술 후 병리학적 병기를 술전에 예측하는데 있어 단일 예측인자로는
PSA가 가장 유용한 것으로 판단되며, MRI 등의 방사선학적 검사를 포함한 임상적 병기는
유용하지 못하였다. Gleason score는 림프절 전이를 예측하는데는 유용한 것으로 판단되나
전립선암의 국소병기를 예측하기에는 부적절하였다. 이와 같은 결과로서 술 전 PSA치가
20ng/㎖이하이고 Gleason score가 7이하일 때 그리고 MRI에서 전립선안에 종양이 국한되어
있다고 판단될 때는 병리학적 병기도 전립선내에 국한되어 있을 가능성이 높으므로 환자의
연령과 건강상태를 고려하여 근치적 전립선적출술을 시행하는 것이 적절한 치료방법이 될
수 있을 것이다.
#초록#
Properative clinical staging in the prostate cancer does not always accurately predict
the surgical-pathological outcome. We evaluated how the clinical staging, and other
clinical parameters including preoperative PSA and Gleason's score could reflect on the
surgico-pathological findings in 30 patients with prostate cancer, who underwent radical
prostatectomy
Twelve of 24 patients with clinical 71 or 72 disease were understaged by clinical
staging determined by digital rectal examination, bone scan, and radiologic studies
including CT and MRI with endorectal coil. MRI with endorectal coil accurately reflected
the extracapsular disease only in 59.1% of 22 patients studied. At the same time, it also
showed low sensitivity (50%) with high specificity (100%) in detecting Iymph node
metastasis
Preoperative levels of PSA in patients with P2, P3, and N+ disease were 17.8±4.5,
47.9±11.3, 93.5±20.5ng/㎖, respectively. The level of PSA was less than 20ng/㎖ in 9 of
12 patients with P2 disease, while they were greater than 20ng/m1 in 9 of 12 patients
with P3 disease. PSA may have a role to nile out Iymph node metastasis when its level
is less than 10ng/㎖ although it did not reach tile statistical significance because of
small sample size.
Gleason's scores in patients with P2 disease were quite similar to those in patients
with P3 disease (5.92±0.69 vs 5.67±0.56), whereas Gleason's scores in all 6 patients
with N disease were 9 or greater.
Neoadjuvant hormonal therapy with LH-RH analogue and androgen receptor blocker
for 1.5 to 3 months had no impact on the reduction of margin positivity or downstaging
in 10 patients. PSA failure rate in patients with P2 and P3 disease was 25% at 1 year
after operation.
PSA is a good marker for differentiating between P2 and P3 disease (p=0.0214) and
can safely rule out N+ disease if its level is below 10ng/㎖, while Gleason's score may
reflect the Iymph node metastasis when it is 9 or greater (p=0.0012). Among the
candidates for radical prostatectomy, selection of the patients on the basis of PSA and
Gleason's score might improve the_ surgical-pathological outcome.
키워드
Prostate cancer; Radical prostatectomy; PSA; Gleason's score; MR imaging;
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