Prostat adenokarsinomlarında iğne biyopsileri ve radikal prostatektomi materyallerinin Gleason skoru açısından karşılaştırılması

Year 2017, Volume: 12 Issue: 1, 25 - 30, 24.04.2017

Tayfun Şahinkanat , Faruk Küçükdurmaz , Erkan Efe , Eyüp Koluş Hasan Çetin Ekerbiçer , Muharrem Bitiren

https://doi.org/10.17517/ksutfd.205510

Abstract

Amaç: Prostat biyopsisiile elde edilen Gleason skoru (GS)lokalize prostat kanseri olgularının tedavi kararında önem taşıdığı için radikal prostatektomi (RP)GSile uyumuoldukça önemlidir. Ancak literatürde bu uyum %24-50 arasında bildirilmektedir. Çalışmamızda kliniğimizde yapılan prostat biyopsileri ile RP sonrası elde edilen patolojik bulguların uyumu değerlendirilmiştir.

Gereç ve Yöntemler: KSÜ Tıp Fakültesi Üroloji Kliniği'nde standart 12 kor transrektalbiyopsi ile prostat kanseri tanısı konan ve sonraki sekiz haftada RP yapılan 24 hastanın patoloji sonuçları retrospektif olarak değerlendirildi. Biyopsilerde GS, kanserli kor sayısı,kanserli korlardaki kanser yüzdesi değerlendirildi. Ayrıca yaş,prostat hacmi,PSA değerlerininbiyopsi ve RP GS’ları arasındaki uyuma etkisi araştırıldı. GS artışı ya da azalışı bir prognostik gruptan diğerine geçiş olarak tanımlandı.Prognostik gruplar GS 6; 7 ve 8≤  olarak kategorize edildi.

 Bulgular: Hastaların ortanca yaşı 68 (58-79) yıl,ortanca PSA değeri 9,65 ng/ml (4.2-149) ve prostat hacmi 46.5 ml'ydi (27-70). Tüm hastalar değerlendirildiğinde yalnızca bir olguda (%4.2) GS düşüşü saptandı. Biyopsisinde GS=6 olan olguların %43.5'sinde (n:7/16) RP GS’unda artışısaptanırken, GS=7 olan 7 hastanın ise sadece birinde GS artışı izlendi. GS=8 olan bir hastanın RP GS biyopsi GS’u ile aynıydı. Prostat biyopsi ve patolojik GS arasındaki genel uyum %62.5ve kappa değeri 0,31(p:0,025) idi. GS artışı ile ileri yaş arasında k:0.47 (p=0.01),PSA> 9 olan 14 vaka için k:0.50 (p=0.021) ve prostat hacmi ≥30 cc olan olgularda k:0.42 (p=0.014) olarak bulundu.

Sonuç: Çalışmamızda iğne biyopsi GS ile RP GS arasındaki uyum oranı literatürle uyumlu bulunmakla birlikte, verilerimiz biyopsi ile daha doğru derecelendirme için yeni teknik yaklaşımlara yönelmemiz gerektiğini düşündürtmektedir.

 Anahtar kelimeler: biyopsi, prostat kanseri, Gleason skoru, radikal prostatektomi

Keywords

Biyopsi, prostat kanseri, Gleason skoru, radikal prostatektomi

Comparison Between Needle Biopsy and Radical Prostatectomy Samples in Assessing Gleason Score in Prostatic Adenocarcinomas

Abstract

Objective:
Prostate
biopsy  Gleason score is important for
treatment planning in patients with localized prostate cancer. Therefore, concordance
between biopsy and radical prostatectomy (RP) pathologies is critically
important. However, discordance rates between those two was reported as 24-50%
in the literature. Aim of present study is to evaluate concordance rates
between biopsy and RP results.

Material
and Methods: A
retrospective review of 24 patients, who underwent prostate biopsy (standart 12
cores) due to elevated PSA or abnormal digital rectal examination and diagnosed
with localised prostate cancer was performed. All patients underwent radical
prostatectomy within 8 weeks after biopsy. Associations between preoperative
clinical factors and Gleason score upgrading were analyzed. Those factors
include Gleason scores, percentage of positive cores, age, prostate volume and
PSA value.  Gleason upgrading or
downgrading was defined as an increase or decrease from one prognostic group to
another. Prognostic groups were categorised as GS 6; 7 and 8≤.

Results: Median age of
patients was68 (58–79) years and median PSA was 9,65 ng/ml (4.2–149). Median
prostate volume was 46,5 ml (27–70). Overall, needle biopsies were under-graded
in 1 (4.2%) cases, overgraded in 8 (33.3%), and correctly graded in 15 (62.5%)
patients. While upgrading was identified in 7 out of 16 (43,5%) patients with
GS 6 on needle biopsy, only one patient with GS=7 on biopsy was upgraded.
Overall concordance between biopsy and pathological GS was 62.5% (p =
0.025) and k value was 0.31. Independent predictors of upgrading were age
(k:0.47 [p=0.01]), PSA> 9 (k:0.50 [p=0.021])
and prostate volume ≥30 cc (k:0.42 [p=0.014]).

Conclusion:
Although
our results were consistent with the literature, new approachs are required to
better grading with biopsy.

Keywords

Biopsy, prostate cancer, Gleason score, radical prostatectomy

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