Efectividad y correlación de la puntuación de Gleason según biopsia de próstata y prostatectomía radical
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2021
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Antecedentes: El cálculo de Gleason Score (GS) establece un pronóstico de sobrevida en el Cáncer de Próstata (CP) que es fundamental para el tratamiento. El GS se hace a partir de Biopsia de próstata (BP) o prostatectomía, siendo la primera una opción menos cruenta y cara. Sin embargo, persisten cuestionamientos en referencia a si el rendimiento pronóstico del GS obtenido a través de BP. Objetivo: Establecer el grado de concordancia que tiene la puntuación de Gleason con los patrones glandulares de adenocarcinoma de próstata obtenidos por biopsia o prostatectomía radical. Metodología: Se realizó un estudio transversal en el que se incluyeron de manera no aleatoria todos los casos de pacientes consecutivos con CP en quienes se calculó el GS mediante BP y prostatectomía radical. Para el análisis de concordancia de variables ordinales se utilizó Tau-c de Kendall debido a que existían variables con más de 2 categorías y para establecer la simetría se calculó el coeficiente d de Somers. Para establecer la correlación de variables numéricas se utilizó el coeficiente de Spearman. Para la comparación de variables numéricas se utilizó la prueba de t de Student-Fisher. Se consideró significativo valor de P < 0.05. Resultados: la clasificación GS de la muestras por BP y Prostatectomía tuvieron asociación moderada y positiva (Tau-c de Kendall 0.435; ES 0,062; P 0.000) con concordancia simétrica y moderada (coeficiente d de Somers simétrico 0.464; Gleason BP dependiente, 0.458; Gleason Prostatectomía dependiente 0.471). Conclusiones existe concordancia significativa y positiva entre la GS obtenido por BP y por prostatectomía, sin embargo, con efectividad moderada.
The calculation of the Gleason Score (GS) establishes a survival prognosis in Prostate Cancer (PC) that is essential at the time of establishing treatment. The GS study can be done from a biopsy or prostatectomy, the former being a more practical option as it avoids a bloody and much more expensive intervention. However, questions persist as to whether the prognostic performance of the GS established from the biopsy is comparable with that estimated from the sample obtained by prostatectomy. Is established the degree of concordance that the Gleason score has with the glandular patterns of the prostate adenocarcinoma obtained by biopsy or radical prostatectomy. A cross-sectional study will be carried out in which all cases of consecutive patients with PC will be included in a non-randomized manner in whom the GS was calculated by biopsy and radical prostatectomy. For the comparison analysis, the double-tailed Mann-Whitney U tests, Chi-square of homogeneity and Fisher's exact test will be used. To estimate the strength of agreement, the Cohen's kappa coefficient will be calculated and to establish the direction of agreement or discordance, the Somers d statistic will be estimated considering significant values of p <0.05. It is expected to verify that there is a high concordance between the GS estimated from prostate biopsies with ultrasound-guided needle and that calculation from samples obtained by prostatectomy
The calculation of the Gleason Score (GS) establishes a survival prognosis in Prostate Cancer (PC) that is essential at the time of establishing treatment. The GS study can be done from a biopsy or prostatectomy, the former being a more practical option as it avoids a bloody and much more expensive intervention. However, questions persist as to whether the prognostic performance of the GS established from the biopsy is comparable with that estimated from the sample obtained by prostatectomy. Is established the degree of concordance that the Gleason score has with the glandular patterns of the prostate adenocarcinoma obtained by biopsy or radical prostatectomy. A cross-sectional study will be carried out in which all cases of consecutive patients with PC will be included in a non-randomized manner in whom the GS was calculated by biopsy and radical prostatectomy. For the comparison analysis, the double-tailed Mann-Whitney U tests, Chi-square of homogeneity and Fisher's exact test will be used. To estimate the strength of agreement, the Cohen's kappa coefficient will be calculated and to establish the direction of agreement or discordance, the Somers d statistic will be estimated considering significant values of p <0.05. It is expected to verify that there is a high concordance between the GS estimated from prostate biopsies with ultrasound-guided needle and that calculation from samples obtained by prostatectomy
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Neoplasias de la próstata, Biopsia, Diagnóstico clínico, Cirugía oncológica, Indicadores (estadística), Hospital SOLCA de Guayaquil, Cantón Guayaquil, Ecuador