혈청 PSA에 따른 전립선 생검조직과 근치적 전립선적출술 조직의 Gleason Score 일치도 비교
Use of Serum PSA in Comparison of Biopsy Gleason Score with Radical Prostatectomy Gleason Score
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김청수
박민수/정한/김태효/홍준혁/박형근/정진수/박노정/박태한
KMID : 0358319980390121241
Abstract
결론
전립선 생검에서의 Gleason score가 고분화도인 경우 술후 Gleason score와 일치도가 낮은
반면 저분화도에서는 그 일치도가 높고, 술전 혈청 PSA치는 술후 병리조직 Gleason scope
와 높은 관련도가 있음을 알 수 있었다. 본 연구에서는 술후 최종병기를 예측하는 인자로서
국소전립선암에 데한 예측은 혈청 PSA가 우수하였고, 골반내 임파선 전이에 대한 예측도는
술전 조직생검의 Gleason scope가 우수하였다. 또한, 생검조직 Gleason scope가 고분화도일
때 술후 병리조직 Gleason scope가 44.4%에서 upgrading되었으며, 특히 혈청 PSA가
30ng/m1 이상일 경우에는 upgrading될 가능성이 더욱 높아졌다 따라서 전립선암 환자의 치
료는 혈청 PSA치를 참고로 하여 PSA가 20ng/ml 이상인 경우 생검조직의 Gleason score가
술후 Gleason score에서 upgrading될 수 있다는 점을 충분히 고려하여야 하며, 술전 국소전
립선암으로 생각되어진 경우라도 혈청 PSA가 높은 경우에 술후 절개면 침투, 피막침범 등
upstaging 가능성을 생각하고 치료시에 보다 정확한 수술적 접근을 하여야 할 것으로 생각
된다.
#초록#
Purpose : The Gleason score of needle biopsies of the prostate and preoperative serum
level of prostate-specific antigen(PSA) are two useful factors in predicting the final
pathological staging of patients with prostate cancer treated by radical prostatectomy.
Unfortunately, the Gleason score of the biopsy cores often differs from the Gleason
score of radical prostatectomy specimen. We evaluated the role of Gleason scores of
biopsy cores and the influence of PSA in predicting the Gleason scores of prostatectomy
specimens and final pathological staging.
Materials and Methods : The records of 52 patients with prostate cancer treated by
radical prostatectomy from June 1990 to June 1997 were reviewed. The patients were
divided into three groups according to the sum of the Gleason scores, i.e. well
differentiated(Gleason score 2-4), intermediate(5-7) and poorly differentiated
tumors(8-10). The concordance between Gleason score of biopsy and prostatectomy
specimen was analysed according to the Gleason score of tumor in biopsy specimen.
Furthermore, we evaluated the different level of PSA could affect the concordance rate
between Gleason scoreofbiopsyandprostatectomyspecimen.
Results : In well-differentiated tumors(Gleason score 2-4) in biopsy specimen, the
concordance rate was 55.6%, In intermediate(5-7) differentiated cancers the Gleason
score remained the same in 68%. In poorly differentiated tumors, the concordance rate
was 72.2%. When PSA was less than 10ng/m1, concordance rate of well differentiated
tumors and poorly differentiated tumors was 75%, 40%, respectively. Whereas the
concordance rate of well differentiated tumors was 50% and that of poorly differentiated
tumors was 90% when the PSA was higher than 20ng/m1. Using linear regression
analysis, the preoperative PSA highly correlated with radical prostatectomy Gleason
score(correlation coefficient(r)=0.38, p =0.005).
Conclusions : The Gleason score of prostatectomy specimen was upgraded in 44.4%
when the biopsy Gleason score was well differentiated, especially when preoperative
PSA was higher than 20ng/m1. Therefore, the significance of biopsy Gleason score in
the clinical application must be used cautiously when it is used to predict the
pathological stage or biological potential of the cancer especially when it is low Gleason
score with high PSA(>20ng/m1). In the meantime, the level of PSA plays an significant
role in determining organ confined disease, while high Gleason scone reflect the Iymph
node positive disease.
키워드
Prostate biopsy; Radical prostatectomy; Gleason score; Prostate specif;
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