Grading of prostatic adenocarcinoma: current state and prognostic implications.
Grading of prostatic adenocarcinoma: current state and prognostic implications.
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DOI：
10.1186/s13000-016-0478-2
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发表时间：
2016-03-09
影响因子：
2.6
通讯作者：
Epstein J
中科院分区：
文献类型：
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作者：
Gordetsky J;Epstein J
尽管前列腺癌的临床和组织学诊断发生了重大变化，格里森分级系统仍然是前列腺癌最有效的预后预测指标之一。前列腺癌的正确诊断和分级对患者的预后和治疗选择至关重要。然而，这一系统已经经历了重大修订，并继续存在可能影响患者护理的缺陷。我们描述了前列腺癌分级的现状，重点介绍了目前的Gleason分级系统指南以及2014年国际泌尿病理学会关于前列腺癌Gleason分级的共识会议的最新变化。我们还探讨了当前格里森评分系统的局限性，并提出了一种经过验证的格里森评分替代方案。新的分级系统最初于2013年在约翰·霍普金斯医院的一项研究中描述，然后在一项多机构研究中得到验证，包括基于修改后的格里森评分组的五个不同的分级组。1级 = Gleason评分≤6，2级 = Gleason评分3 + 4 = 7，3级 = Gleason评分4 + 3 = 7，4级 = Gleason评分8，5级 = Gleason评分9和10。由于这种新的评分系统更简单，更准确地反映前列腺癌生物学，世界卫生组织建议将其与Gleason评分结合使用。
Despite significant changes in the clinical and histologic diagnosis of prostate cancer, the Gleason grading system remains one of the most powerful prognostic predictors in prostate cancer. The correct diagnosis and grading of prostate cancer is crucial for a patient’s prognosis and therapeutic options. However, this system has undergone significant revisions and continues to have deficiencies that can potentially impact patient care. We describe the current state of grading prostate cancer, focusing on the current guidelines for the Gleason grading system and recent changes from the 2014 International Society of Urological Pathology Consensus Conference on Gleason Grading of Prostatic Carcinoma. We also explore the limitations of the current Gleason grading system and present a validated alternative to the Gleason score. The new grading system initially described in 2013 in a study from Johns Hopkins Hospital and then validated in a multi-institutional study, includes five distinct Grade Groups based on the modified Gleason score groups. Grade Group 1 = Gleason score ≤6, Grade Group 2 = Gleason score 3 + 4 = 7, Grade Group 3 = Gleason score 4 + 3 = 7, Grade Group 4 = Gleason score 8, Grade Group 5 = Gleason scores 9 and 10. As this new grading system is simpler and more accurately reflects prostate cancer biology, it is recommended by the World Health Organization (WHO) to be used in conjunction with Gleason grading.