engleski

Prognostic significance of contemporary prostate cancer grading system in tumours with positive surgical margins

Introduction: Pre-operative serum PSA, Gleason pathological grade, positive surgical margins and capsular incision are significant in predicting clinical and biochemical recurrence of the disease treated with prostatectomy. The modified Gleason classification uses prognostic groups that better reflect the true biological nature of disease. Method: 121 patients with acinar type prostate adenocarcinoma were selected following radical prostatectomy with acompaning clinical and histopathological data. Patient groups were divided according to the stage and the positive surgical margins and Ki67 index of proliferation. The outcome was based on the data of biochemical recurrence. We compared the prognostic impact of old and new Gleason classification using standard statistical methods. Results: By analyzing both Gleason systems (an average score and prognostic groups) comparing groups with a positive and negative margin, a significantly larger Gleason score was found in group with a positive margin (p=0, 003). The significant correlation of biochemical recurrence with new Gleason prognostic groups was also found (p=0, 048) but not in patients with tumours with positive margins after prostatectomy. Ki67 proliferation index significantly correlated with prognostic Gleason group system, also in tumours with positive margins (p=0, 0012 and p=0, 0028 ; respectively). Conclusion: The new Gleason prognostic groups in combination with other prognostic markers could provide better characterization of tumours with positive surgical margins in patients treated with radical prostatectomy.

Prostate cancer; Gleason classification; Prognosis

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