Evaluation du score de gleason sur biopsie prostatique versus prostatectomie radicale dans le cancer de la prostate
Mots-clés :
Prostate - Adénocarcinome -Biopsie - Prostatectomie -AnatomopathologieRésumé
Introduction:
Le traitement du cancer de la prostate repose sur la détermination du score histopronostique de Gleason sur les biopsies prostatiques. Cependant, l'examen histologique final peu révéler une discordance du score de Gleason entre la biopsie prostatique et la prostatectomie radicale.
Le but de ce travail était d'évaluer la concordance du score de Gleason entre les biopsies prostatiques et les prostatectomies radicales et d'étudier les facteurs prédictifs de sous-estimation du ce score sur les biopsies prostatiques.
Méthodes :
Il s'agit d'une étude rétrospective. Nous avons procédé à la relecture de 30 cas de prostatectomies radicales réalisées entre 2008 et 2015 ainsi que17 biopsies prostatiques correspondantes; Les données des 13 biopsies prostatiques restantes, réalisées en ville, ont été rapportées à partir des comptes rendus histologiques bien détaillés.
Résultats :
Nos résultats ont montré que la concordance selon le score de Gleason était de 43% (Kappa= 0.11 signifiant un accord très faible).
Le score de Gleason était sous-estimé sur les prélèvements biopsiques dans 54% des cas. Sur pièce de prostatectomie radicale, il a augmenté de deux points de grade dans un cas et d'un point de grade dans 14 cas.
En utilisant la nouvelle classification de l'ISUP 2014. La biopsie prostatique a sous-estimé le score de Gleason dans 78% des cas pour le groupe 1 (SG 3+3) et de 63% pour le groupe 2 (SG 3+4).
Pour les différents facteurs prédictifs de discordance étudiés (âge, taux de PSA [prostate specific antigen] sérique, nombre de carottes biopsiques,pourcentage de carottes tumorales...), nous n'avions pas pu montrer une différence statistiquement significative quant à la sous-estimation du score de Gleason sur biopsie prostatique.
Conclusion :
Ainsi, le taux de discordance important du score de Gleason entre les biopsies prostatiques et les prostatectomies radicales, incite à une bonne connaissance des facteurs prédictifs de discordance de ce score, permettant aux urologues, pathologistes et oncologues de prendre en charge les patients d'une façon plus appropriée en choisissant la modalité thérapeutique adéquate pour chaque patient.
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Références
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