Analysis Of Factors Related To Gleason Score Increase In Histopathological Results Compared With Needle Biopsy After Radical Prostatectomy

Objective:The Gleason score of prostate tissue samples after radical Prostatectomy was more than 30%higher than that of biopsies.In order to accurately judge the clinical conditions for clinicians to determine the follow-up treatment program to provide assistance.The purpose of this study was to explore the factors associated with the increase in pathological grade of the post-radical Prostatectomy Group compared with the biopsy group based on the Gleason score on prostate tissue of International Society of Urology and pathology(2014 edition).Methods:The clinical data of PCa patients who underwent prostate biopsy and RP surgery in the First Hospital of Shanxi Medical University from January 2018 to December 2021were retrospectively analyzed.We collected the following clinical data,including the patient’s age,body mass index,total PSA,free PSA,f/t PSA,lymphocytes,neutrophils,monocytes,eosinophils,platelets,Neutrophil-lymphocyte ratio,platelets-lymphocytes ratio,lymphocytes-monocytes ratio,eosinophils-lymphocytes ratio,prostate Volume,PSAD,number of positive needles,total needles for puncture biopsy,Gleason score and grading of biopsy,Gleason score and grading of specimens after radical Prostatectomy,interval time between puncture and RP,and so on.According to whether the Gleason group level increased after radical Prostatectomy,the patients were divided into two group,one is a upgraded group and another is a non-upgraded group.The differences between the two groups was used to analyze the increased pathological group level under the 2014 ISUP criteria by t test,X~2test and the multivariate Logistic regression model.Results:A total of 162 patients with prostate cancer were included in this study;general data were median age 69(63,74)years,BMI(24.54±2.91)kg/m2,t PSA 14.98(9.00,25.95)ug/L,prostate volume 38.72(29.31,58.88)ml,PSAD 0.36(0.21,0.69),and The interval between puncture and RP was 16(11.00,25.00)days;Gleason’s grade of puncture biopsy was 51(31.5%),30(18.5%),24(14.8%),31(19.1%),and 26(16.6%)for grade 1,grade 2,grade 3,grade 4,and grade 5.55(33.95%)cases were upgraded in the pathology group after RP.The pathology group level was reduced in 33 cases(20.37%),and the case group level matched in 74 cases(45.6%).The results of multifactorial logistic regression analysis showed that puncture secondary score and prostate volume(OR=0.977,P=0.017)were independent influencing factors for pathology group grade escalation after RP,in which the pathology group grade escalation occurred 2.685 times more in the prostate volume≤25 ml group than in the≥40 ml group after RP.Conclusion:1.according to the 2014 edition of the International Society of Urological Pathology(ISUP)Gleason score five-grade grouping method,postoperative pathological results of RP still showed 33.95%of patients with group-level elevation of Gleason score compared with preoperative puncture pathological results.2.Smaller prostate volume and puncture secondary score are independent factors associated with the occurrence of Gleason score group-level elevation after RP,and subgroup analysis showed that the occurrence of pathological group-level elevation after RP was 2.685 times higher in the prostate volume≤25 ml group than in the≥40 ml group;the possibility of Gleason score group-level elevation after RP should be fully recognized in clinical work,and a more accurate treatment plan should be selected.The possibility of elevated Gleason score after RP should be fully recognized in clinical work,and a more accurate treatment plan should be selected.