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目的评价前列腺穿刺活检下前列腺癌(prostatic cancer,PCa)患者Gleason评分对肿瘤发生部位预测的可靠性,分析根治术后出现切缘阳性(positive surgical margins,PSM)的相关影响因素。方法前列腺癌患者72例,术前均行前列腺穿刺活检,并与根治切除术后的病理进行对比分析,应用统计软件分析各指标间的相关性。结果穿刺病理与根治切除病理的Gleason评分基本一致;穿刺阳性多集中在外周靠近底部的4点,穿刺结果提示的肿瘤分布与根治病理的肿瘤分布一致性较差。术前相关临床指标中,穿刺Gleason评分及穿刺阳性针数百分比对切缘阳性有独立的预测意义,穿刺各针中F、L两点与切缘阳性存在较高的相关性。结论前列腺穿刺Gleason可作为患者病理分级的有效依据;当穿刺Gleason评分>7.25,阳性针数比例>45.0%,穿刺阳性位置靠近前列腺尖部时手术后出现切缘阳性的可能性增加。
Objective To evaluate the reliability of Gleason score in predicting tumor location in patients with prostatic cancer (PCa) undergoing prostate biopsy and to analyze the influencing factors of positive surgical margins (PSM) after radical operation. Methods Totally 72 patients with prostate cancer underwent prostate biopsy before operation and compared with the pathology after radical resection. Statistical software was used to analyze the correlation between the indexes. Results The Gleason score of the biopsy was basically the same as that of the radical excision. The puncture-positive was mostly concentrated in the periphery at the bottom of 4 points. The puncture results suggested that the tumor distribution was not consistent with the radical pathology. Among the preoperative clinical indexes, the Gleason score and the percentage of positive stitches had independent predictive value on the positive margins. There was a high correlation between the two points F and L and the positive margins. Conclusions Gleason prostate biopsy can be used as a valid basis for the pathological grading of patients. When the Gleason score> 7.25, the positive stitch number> 45.0%, the positive margins after surgery are more likely to occur when the puncture positive position is near the tip of the prostate.