근치적 전립선적출술 후 Gleason 점수가 7인 전립선암 환자군에서 Gleason 점수 3+4인 경우와 4+3인 경우의 임상학적, 병리학적 특성 비교
Comparative Analysis of the Clinicopathological Characteristics of Patients with Prostate Cancer with a Pathological Gleason Score 3+4 versus Gleason Score 4+3
유지형, 조민철, 장인호, 한준현, 한병규, 정성진, 홍성규, 변석수, 최기영, 이상은,
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유지형 ( Yu Ji-Hyeong )
인제대학교 의과대학 상계백병원 비뇨기과학교실
조민철 ( Cho Min-Chul )
서울대학교 의과대학 비뇨기과학교실
장인호 ( Chang In-Ho )
한전의료재단 한일병원 비뇨기과학교실
한준현 ( Han Jun-Hyun )
한전의료재단 한일병원 비뇨기과학교실
한병규 ( Han Byoung-Kyu )
분당서울대학교병원 비뇨기과
정성진 ( Jeong Seong-Jin )
분당서울대학교병원 비뇨기과
홍성규 ( Hong Sung-Kyu )
분당서울대학교병원 비뇨기과
변석수 ( Byun Seok-Soo )
분당서울대학교병원 비뇨기과
최기영 ( Choe Ghee-young )
분당서울대학교병원 병리학과
이상은 ( Lee Sang-Eun )
분당서울대학교병원 비뇨기과
KMID : 0358320070480080804
Abstract
Purpose: Gleason score(GS) 7 tumors contain patterns 3 and 4 in various proportions. The clinical and pathological characteristics of patients with GS 3+4 and GS 4+3 found during a radical prostatectomy(RP) were retrospectively evaluated.
Materials and Methods: 124 cases of GS 7 prostate cancer were identified between April 2004 and February 2006. None of these patients had received either preoperative hormonal therapy, including 5?-reductase inhibitors, or radiation therapy. After classifying patients with GS 7 tumors into those with GS 4+3 and GS 3+4 tumors, the two groups were compared according to various clinicopathological parameters.
Results: In total, 84(67.7%) and 40(32.3%) of patients had final GS of 3+4 and 4+3, respectively. A final GS of 4+3 was associated with a higher pre-biopsy level of prostate-specific antigen(p＜0.001) and a higher biopsy Gleason sum(p＜0.001). Also, a higher pathological T stage(p=0.005), tertiary Gleason pattern 5(p＜0.001), seminal vesicle invasion(p=0.008), bladder neck invasion(p=0.002), angiolymphatic invasion(p=0.008), perineural invasion(p=0.045), positive surgical margins(p=0.038) and larger tumor volumes(p＜0.001) were associated with GS of 4+3.
Conclusions: Our results demonstrated that the statistically significant differences exist between GS 3+4 and 4+3 prostate cancers. Thus, GS 7 prostate cancers may be considered heterogeneous in their biological behaviors, and GS 7 prostate cancers with a GS of 4+3 may be considered more aggressive tumors compared to those with a GS of 3+4.
키워드
Prostatic neoplasms; Gleason score; Prostatectomy
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