The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment

GÖĞÜŞ, Orhan; HALİLOGLU, AHMET HAKAN; DEMİRELLİ, Erhan; SÖNMEZ, MEHMET GİRAY

The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment

Mehmet Giray SÖNMEZ, (Ufuk Üniversitesi, Tıp Fakültesi, Üroloji Anabilim Dalı, Ankara, Türkiye)

Ahmet Hakan HALİLOĞLU, (Ufuk Üniversitesi, Tıp Fakültesi, Üroloji Anabilim Dalı, Ankara, Türkiye)

Erhan DEMİRELLİ, (Ufuk Üniversitesi, Tıp Fakültesi, Üroloji Anabilim Dalı, Ankara, Türkiye)

Orhan GÖĞÜŞ (Ufuk Üniversitesi, Tıp Fakültesi, Üroloji Anabilim Dalı, Ankara, Türkiye)

Türk Üroloji Dergisi/Turkish Journal of Urology

4 0

Yıl: 2012 Cilt: 38 Sayı: 4 Sayfa Aralığı: 177 - 184 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment

Öz:

Amaç: Bu çalışmada amaç, radikal prostatektomi (RP) spesmenlerinde yüksek tersiyer patern bulunmasının histopatolojik sonuçlar ve PSA progresyonu üzerine etkisini değerlendirmektir. Gereç ve yöntemler: Çalışmada kliniğimizde ocak 2007-ocak 2011 tarihleri arasında klinik lokalize prostat kanseri tanısı ile radikal prostatektomi operasyonu uygulanmış ve günümüze kadar takibe düzenli olarak gelmiş olan, gleason skoru 5-8 (5 ve 8 dahil) olan, 71 hastanın spesmenleri tek patolog tarafından tekrar incelenmiştir. Hastalar yüksek tersiyer gleason patern (gleason 4 veya 5) bulunması açısından değerlendirildi. Tersiyer paternin bulunmasının histopatolojik sonuçlar ve PSA progresyonu üzerine etkisi araştırıldı. Hastalar ilk iki yıl 3 ayda bir, sonraki 2 yıl 6 ayda 1, sonrasında yılda bir serbest ve total PSA ölçümü ve dijital rektal muayene yapılarak takip edildi. PSA progresyonu serum total PSA değerinin 0.2 ng/mL ve daha üzerindeki artışı olarak kabul edildi. Bu çalışmada istatistiksel analiz SPSS for Windows Version 15.0 paket programında yapıldı. Sonuçlar da, anlamlılık p<0.05 düzeyinde değerlendirilmiştir. Bulgular: RP spesmenlerinde yüksek tersiyer patern bulunma oranı %15.4 olarak saptandı. Hastalar tersiyer patern pozitif ve negatif olarak sınıflandırıldı. Tersiyer patern pozitif grupta diğer gruba göre preoperatif PSA değerinin yüksek olduğu (p=0.469), extrakapsüler yayılım (p değeri= 0.031), lenf nodu invazyonu (p=0.05), seminal vezikül invazyonunun (p=0.022) daha fazla görüldüğü, patolojik evrenin daha yüksek olduğu (p=0.005) saptandı. Hastalar postoperatif ortalama 36,3 ay takip edildi. Tersiyer patern pozitif grupta anlamlı olarak PSA rekkürensi daha fazla (p=0.001) ve PSA progresyon zamanı daha kısa olarak (p=<0.001) tespit edildi. Her iki grupta da preoperatif yaş, klinik evre, gleason skorları, cerrahi sınır pozitifliği açısından istatistiksel olarak anlamlı fark olmadığı bulundu. Çok değişkenli Cox regresyon analizde yüksek tersiyer patern, ekstrakapsüler yayılım, seminal vezikül invazyonu , cerrahi sınır pozitifliği ve gleason skorların PSA rekkürensi üzerine etkisi incelendiğinde sadece yüksek tersiyer patern bulunmasının PSA rekkürensi üzerine anlamlı etkisi olduğu belirlendi (p=0.034). Sonuç: Radikal prostatektomi spesmenlerinde tüm gleason skorlarda yüksek tersiyer patern bulunması kötü histopatolojik sonuçlar ve postoperatif biyokimyasal başarısızlık ile ilişkilidir. Bu konuda daha fazla sayıda hasta ile yapılan ve daha uzun takip süresi olan prospektif çalışmaların tersiyer paternin prognostik değerini daha net ortaya koyacağı düşüncesindeyiz

Anahtar Kelime:

Konular: Üroloji ve Nefroloji

Radikal prostatektomi spesmenlerinde yüksek tersiyer gleason patern bulunmasının histopatolojik sonuçlar ve biyokimyasal başarısızlık üzerine etkisi

Öz:

tectomy (RP) specimens on the histopathological results and PSA progression. Material and methods: In this study, specimens from 71 patients with clinically localized prostate cancer who underwent RP between January 2007 and January 2011 in our department, who regularly attended their follow-up visits and who had a Gleason score of 5-8 (5 and 8 included) were reanalyzed by a single pathologist. The patients were evaluated for the presence of a high-grade tertiary Gleason pattern (Gleason 4 or 5). We investigated the effect of the tertiary pattern on the histopathological results and PSA progression. The patients were followed with testing for the free and total levels of PSA and given a digital rectal examination quarterly for the first two years, semiannually for the next 2 years, and annually for the remaining period. An increase in the serum total PSA count of 0.2 ng/mL or more was considered to represent PSA progression. The statistical analysis in this study was performed with SPSS for Windows Version 15.0 (Inc., Chicago, IL). p<0.05 was accepted as significant. Results: The incidence of a high-grade tertiary pattern in RP specimens was found to be 15.4%. The patients were categorized into groups that were positive or negative for a tertiary pattern. When compared with the other group, the tertiary pattern positive group had higher preoperative PSA levels (p=0.469), more frequent extracapsular extension (p=0.031), more frequent lymph node (p=0.05) and seminal vesicle invasion (p=0.022) and more advanced disease in terms of the pathological stage (p=0.005). The patients were followed up for an average of 36,3 months postoperatively. PSA recurrence was found to be significantly higher in the tertiary pattern positive group (p=0.001), and the PSA progression time was shorter (p=0.001). There was no statistically significant difference between the two groups in terms of preoperative age, clinical stage, Gleason score and surgical margin positivity. When we investigated the effects of a high-grade tertiary pattern, extracapsular extension, seminal vesicle invasion, surgical margin positivity and Gleason scores on PSA recurrence according to the multivariate Cox regression analysis, only the presence of a highgrade tertiary pattern had a significant effect on PSA recurrence (p=0.034). Conclusion: The presence of a high-grade tertiary pattern in the Gleason scores of RP specimens is associated with poor histopathological results and with postoperative biochemical failure. We believe that prospective studies with a higher number of patients and longer follow-up periods will more distinctly reveal the prognostic value of the tertiary pattern.

Anahtar Kelime:

Konular: Üroloji ve Nefroloji

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	SÖNMEZ M, HALİLOGLU A, DEMİRELLİ E, GÖĞÜŞ O (2012). The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment. , 177 - 184.
Chicago	SÖNMEZ MEHMET GİRAY,HALİLOGLU AHMET HAKAN,DEMİRELLİ Erhan,GÖĞÜŞ Orhan The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment. (2012): 177 - 184.
MLA	SÖNMEZ MEHMET GİRAY,HALİLOGLU AHMET HAKAN,DEMİRELLİ Erhan,GÖĞÜŞ Orhan The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment. , 2012, ss.177 - 184.
AMA	SÖNMEZ M,HALİLOGLU A,DEMİRELLİ E,GÖĞÜŞ O The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment. . 2012; 177 - 184.
Vancouver	SÖNMEZ M,HALİLOGLU A,DEMİRELLİ E,GÖĞÜŞ O The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment. . 2012; 177 - 184.
IEEE	SÖNMEZ M,HALİLOGLU A,DEMİRELLİ E,GÖĞÜŞ O "The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment." , ss.177 - 184, 2012.
ISNAD	SÖNMEZ, MEHMET GİRAY vd. "The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment". (2012), 177-184.

APA	SÖNMEZ M, HALİLOGLU A, DEMİRELLİ E, GÖĞÜŞ O (2012). The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment. Türk Üroloji Dergisi/Turkish Journal of Urology, 38(4), 177 - 184.
Chicago	SÖNMEZ MEHMET GİRAY,HALİLOGLU AHMET HAKAN,DEMİRELLİ Erhan,GÖĞÜŞ Orhan The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment. Türk Üroloji Dergisi/Turkish Journal of Urology 38, no.4 (2012): 177 - 184.
MLA	SÖNMEZ MEHMET GİRAY,HALİLOGLU AHMET HAKAN,DEMİRELLİ Erhan,GÖĞÜŞ Orhan The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment. Türk Üroloji Dergisi/Turkish Journal of Urology, vol.38, no.4, 2012, ss.177 - 184.
AMA	SÖNMEZ M,HALİLOGLU A,DEMİRELLİ E,GÖĞÜŞ O The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment. Türk Üroloji Dergisi/Turkish Journal of Urology. 2012; 38(4): 177 - 184.
Vancouver	SÖNMEZ M,HALİLOGLU A,DEMİRELLİ E,GÖĞÜŞ O The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment. Türk Üroloji Dergisi/Turkish Journal of Urology. 2012; 38(4): 177 - 184.
IEEE	SÖNMEZ M,HALİLOGLU A,DEMİRELLİ E,GÖĞÜŞ O "The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment." Türk Üroloji Dergisi/Turkish Journal of Urology, 38, ss.177 - 184, 2012.
ISNAD	SÖNMEZ, MEHMET GİRAY vd. "The effect of the presence of a high-grade tertiary Gleason pattern in radical prostatectomy specimens on histopathological results and failure of biochemical treatment". Türk Üroloji Dergisi/Turkish Journal of Urology 38/4 (2012), 177-184.