Prognostic Gleason grade grouping: data based on the modified Gleason scoring system.
Prognostic Gleason grade grouping: data based on the modified Gleason scoring system.
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DOI：
10.1111/j.1464-410x.2012.11611.x
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发表时间：
2013-05
影响因子：
4.5
通讯作者：
Epstein JI
中科院分区：
文献类型：
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作者：
Pierorazio PM;Walsh PC;Partin AW;Epstein JI
•调查国际泌尿病理学会（ISUP）最近修改Gleason系统以来的病理和短期结果，试图将当前的Gleason分级系统划分为预后准确的Gleason分级组。•我们查询了经机构审查委员会批准的约翰霍普金斯根治性前列腺切除术数据库（1982-2011），包括自2004年以来接受根治性前列腺切除术（RP）的男性，其中7869名男性没有第三期模式。•使用术前和术后变量创建多变量模型；预后分级组（Gleason分级≤6；3 + 4;4 + 3;8;9-10）是生化无复发（BFS）生存的最强预测因子之一。•活检时Gleason分级组之间存在显著差异；在种族、PSA水平、临床分期、活检阳性核数和RP Gleason分级组中阳性核的最大百分比方面存在差异。•随访中位（范围）为2（1-7）年，活检中Gleason分级≤6、3 + 4、4 + 3、8和9-10肿瘤患者的5年BFS率分别为94.6、82.7、65.1、63.1和34.5%（趋势P < 0.001）；RP病理差异分别为96.6、88.1、69.7、63.7、34.5% （P < 0.001）。•2005年ISUP对Gleason前列腺癌分级系统进行了修改，根据病理结果和短期生化结果准确地对患者进行了分类，但在保留Gleason分级系统本质的同时，需要对其报告进行更改，以更紧密地反映肿瘤行为。•我们建议报告Gleason分级，包括准确反映预后的预后分级组：Gleason评分≤6（预后分级I组）；Gleason评分3+4=7（预后分级II组）；Gleason评分4+3=7（预后分级III组）；Gleason评分4+4=8(预后分级组（IV）；Gleason评分9 ~ 10分（预后分级组(V)）。
• To investigate pathological and short-term outcomes since the most recent Gleason system modifications by the International Society of Urological Pathology (ISUP) in an attempt to divide the current Gleason grading system into prognostically accurate Gleason grade groups. • We queried the Johns Hopkins Radical Prostatectomy Database (1982–2011), approved by the institutional review board, for men undergoing radical prostatectomy (RP) without a tertiary pattern since 2004 and identified 7869 men. • Multivariable models were created using preoperative and postoperative variables; prognostic grade group (Gleason grade ≤6; 3 + 4; 4 + 3; 8; 9–10) was among the strongest predictors of biochemical recurrence-free (BFS) survival. • Significant differences were noted among the Gleason grade groups at biopsy; differences were noted in the race, PSA level, clinical stage, number of positive cores at biopsy and the maximum percentage of positive cores among the Gleason grade groups at RP. • With a median (range) follow-up of 2 (1–7) years, 5-year BFS rates for men with Gleason grade ≤6, 3 + 4, 4 + 3, 8 and 9–10 tumours at biopsy were 94.6, 82.7, 65.1, 63.1 and 34.5%, respectively (P < 0.001 for trend); and 96.6, 88.1, 69.7, 63.7 and 34.5%, respectively (P < 0.001), based on RP pathology. • The 2005 ISUP modifications to the Gleason grading system for prostate carcinoma accurately categorize patients by pathological findings and short-term biochemical outcomes but, while retaining the essence of the Gleason system, there is a need for a change in its reporting to more closely reflect tumour behaviour. • We propose reporting Gleason grades, including prognostic grade groups which accurately reflect prognosis as follows: Gleason score ≤6 (prognostic grade group I); Gleason score 3+4=7 (prognostic grade group II); Gleason score 4+3=7 (prognostic grade group III); Gleason score 4+4=8 (prognostic grade group (IV); and Gleason score 9–10 (prognostic grade group (V).