Outcome of Gleason 3+5=8 Prostate Cancer Diagnosed on Needle Biopsy: Prognostic Comparison with Gleason 4+4=8
Outcome of Gleason 3+5=8 Prostate Cancer Diagnosed on Needle Biopsy: Prognostic Comparison with Gleason 4+4=8
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DOI：
10.1016/j.juro.2016.05.105
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发表时间：
2016-10-01
影响因子：
6.6
通讯作者：
Iczkowski, Kenneth A.
中科院分区：
文献类型：
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作者：
Harding-Jackson, Nicholas;Kryvenko, Oleksandr N.;Iczkowski, Kenneth A.
目的：ISUP(国际泌尿病理学会)和WHO采用1-5级预后分级，简化了前列腺癌的预后分级。4级组为Gleason评分8分的癌症，它是异质性的，包括Gleason评分4+4-8、3+5-8和5+3-8。这些不同的Gleason评分在复查幻灯片后没有被泌尿外科病理学家研究过对预后的影响。材料和方法：Gleason评分最高为3+5-8或4+4-8的患者纳入研究。对照组为Gleason评分最高为4+3-7或9-10的病例。我们回顾了2005-2013年间在2个机构收治的423例前列腺活检病例。结果：在Gleason评分为8分的癌症中，Gleason评分为3+5-8的51例男性患者的癌症预后略差于Gleason评分为4+4-8的114例男性患者(p=0.04)。这是由Gleason评分为3+5-8的患者中37%的持续非转移性(放疗/激素治疗后)癌症发生率推动的，而在Gleason评分为4+4-8的患者中为24%。相反，随访36个月时，3+5组的肿瘤特定生存率为97.8%，4+4组为92.6%，但差异无统计学意义(p=0.089)。在Gleason评分为8分的组中，筛状生长的存在将癌症的特殊存活率分为两组(p=0.018)。在70例前列腺癌手术患者中，所有Gleason评分分类在活检阳性细胞率、临床表现或病理结果(包括Gleason分型5的频率)方面均无差异。结论：根据目前最新的前列腺癌分级标准，Gleason评分3+5~8和4+4~8的前列腺癌预后无差异。这证明有理由将两者都纳入四年级组。
Purpose: ISUP (International Society for Urologic Pathology) and WHO adopted prognostic Grade Groups 1 to 5 that simplify prostate cancer grading for prognosis. Grade Group 4 is Gleason score 8 cancer, which is heterogeneous, and it encompasses Gleason score 4 + 4 - 8, 3 + 5 - 8 and 5 + 3 - 8. The comparative prognostic implications of these various Gleason scores had not been studied by urological pathologists after a re-review of slides.Materials and Methods: Patients with a highest biopsy Gleason score of 3 + 5 - 8 or 4 + 4 - 8 were included in the study. Controls were cases with a highest Gleason score of 4 + 3 - 7 or 9-10. A total of 423 prostatic biopsy cases accessioned from 2005 to 2013 at 2 institutions were reviewed. Clinicopathological findings and followup (median 33.4 months) were assessed.Results: Among Gleason score 8 cancers the cancer status outcome in 51 men with Gleason score 3 + 5 - 8 was marginally worse than in 114 with Gleason score 4 + 4 - 8 (p = 0.04). This was driven by a persistent nonmetastatic (after radiation/hormone therapy) cancer rate of 37% among Gleason score 3 + 5 - 8 cases vs 24% among Gleason score 4 + 4 - 8 cases. Conversely, cancer specific survival at 36-month followup was 97.8% in 3 + 5 cases vs 92.6% in 4 + 4 cases but this was not significant (p = 0.089). Cancer specific survival in the Gleason score 8 group was dichotomized by the presence of cribriform growth (p = 0.018). All Gleason score categories did not differ in the fraction of biopsy cores positive, clinical presentation or pathological findings, including the frequency of Gleason pattern 5, in 70 patients who underwent prostatectomy.Conclusions: Using the most current standards of prostate cancer grading the prognosis is not different in Gleason score 3 + 5 - 8 and 4 + 4 - 8 cancers. This justifies including both in Grade Group 4.