【摘要】 目的　探讨联合临床参数分期和磁共振成像 (MRI)分期预测前列腺癌病理分期的临床意义。　方法　对 5 3例经病理活检证实的局限性前列腺癌行根治性手术者术前经血清PSA(临界值16 .3ng/ml)加系统 6～ 8针穿刺后Gleason评分 (临界值 6分 )或穿刺阳性针数百分率 (临界值 34%～5 0 % )进行临床分期及MRI分期以预测术后病理分期 ,评价术前联合临床参数分期和MRI分期与病理分期的一致性。　结果　 5 3例中 ,术前血清PSA加Gleason评分低于临界值 ,临床分期局限于前列腺内的肿瘤 (T2 ) 2 0例 ,术后有 2 5 .0 % (5 / 2 0 )为T3 ;术前血清PSA加穿刺阳性针数百分率低于临界值 ,临床分期为T2 2 0例 ,术后 30 % (6 / 2 0 )为T3 。术前临床参数分期为T3 者术后分别有 30 .3% (10 / 33)和30 .3% (10 / 33)为T2 。MRI诊断的 4 8例前列腺癌者中 ,术前分期局限于前列腺内的肿瘤 (T2 ) ,术后病理分期 4 2 .4 % (14 / 31)为T3 ,其中 1例为T2 N1;术前MRI分期为T3 者 ,术后 11.8% (2 / 17)为T2 ,5 .9%(1/ 17)术后为T3cN1。联合临床参数分期和MRI分期预测前列腺癌的病理结果有显著相关性 (r =0 .4 4 9,P =0 .0 0 1) ,且能预测病理结果 (χ2 =10 .739,P =0 .0 0 1) ,3种分期方法之间对前列腺癌病理结果的预测差异无统计学意义 (χ更多还原

【Abstract】 Objective To evaluate the clinical significance of combining clinical parameter staging and magnetic resonance imaging (MRI) staging for prostate cancer before radical prostatectomy. Methods The data of 53 patients with organ confined prostate cancer were reviewed to assess the accuracy of combining clinical parameter staging and MRI staging in correlation with pathological staging results after radical prostatectomy. Results Of the 53 prostate cancer cases,20 were of stage T 2 preoperatively,but 5 (25%) of the 20 were pathologically diagnosed as stage T 3 after prostatectomy when serum PSA<16.3 ng/ml plus biopsy Gleason score<6.Twenty of the 53 prostate cancer cases were of stage T 2,but 6 (30%) of the 20 were pathologically diagnosed as T 3 after prostatectomy when serum PSA<16.3 ng/ml plus the percentage of positive prostate biopsies<34%-50%.Thirty three of the 53 cases were of stage T 3 clinically,10 of the 33 were pathologically diagnosed as T 2 after prostatectomy in combining clinical parameter staging.In MRI staging,31 of the 48 prostate cancer cases were of T 2.Of the 31 cases,14 (42.4%) were of T 3 and 1 (3.2%) was of T 2N 1 pathologically after prostatectomy.Of the 17 cases who were of T 3 with MRI,2 (11.8%) were of pathological T 2 and 1 (5.9%) of pathological T 3N 1.The clinical parameter staging (ie,serum PSA plus biopsy Gleason score or the percentage of positive biopsies) and MRI staging had more correlation with pathological staging results ( r=0.449,P =0.001),and could predict pathological staging results (χ 2=10.739, P = 0.001 ),but there was no significant difference among these 3 staging methods (χ 2=0.305, P = 0.859 ).The predicting rate of the 3 methods for staging organ confined prostate cancer (PPV) were 75%(15/20),70% (14/20) and 54.8% (17/31),respectively,and for non organ confined prostate cancer (NPV) were 69.7 %(23/33), 69.7 %(23/33) and 88.2%(15/17),respectively. Conclusions All these methods can predict pathological staging results.The combined clinical parameter staging methods are more specific and accurate than the MRI staging method for predicting pathological staging results in organ confined prostate cancer,while the MRI staging is more accurate for predicting non organ confined prostate cancer before radical prostatectomy.更多还原