Gleason Score and Lethal Prostate Cancer: Does 3+4=4+3?
Gleason Score and Lethal Prostate Cancer: Does 3+4=4+3?
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DOI：
10.1200/jco.2008.20.4669
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发表时间：
2009-07-20
影响因子：
45.3
通讯作者：
Mucci, Lorelei A.
中科院分区：
文献类型：
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作者：
Stark, Jennifer R.;Perner, Sven;Mucci, Lorelei A.
目的Gleason分级是预测前列腺癌（PCa）预后的重要指标。使用替代PCa终点的研究表明，Gleason评分（GS）7癌症的结局根据模式4的优势而变化。这些研究影响了临床实践，但尚不清楚3 + 4和4 + 3肿瘤的PCa死亡率是否不同。使用前列腺癌死亡率作为主要终点，我们比较了格里森3 + 4和4 + 3癌症的结局，以及GS从标准化审查与原始scoring.Patients和方法的预测能力三个研究病理学家进行了盲法标准化审查693前列腺切除术和119活检标本分配原发性和继发性格里森模式。肿瘤标本来自1984年至2004年诊断的PCa患者，来自医生健康研究和健康专业人员随访研究。致死性PCa（n = 53）定义为发生骨转移或PCa死亡。根据原始GS和标准化GS估计风险比（HR）。我们比较了歧视的标准化和原始分级与C-统计模型的10年survival.Results切除术标本，4 + 3癌症与致命的PCa增加三倍相比，3 + 4癌症（95%CI，1.1至8.6）。与原始评分模型（Gleason 4模式在GS 7癌中的优势，Gleason 4模式在GS 7癌中的优势可能隐藏重要的预后信息）相比，Gleason 4模式在GS 7癌中的优势（Gleason 4模式在GS 7癌中的优势，Gleason 4模式在GS 7癌中的优势，Gleason 4模式在GS 7癌中的优势，Gleason 4模式在GS 7癌中的优势可能隐藏重要的预后信息）。GS的标准化审查可以提高PCa生存率的预测。
Purpose Gleason grading is an important predictor of prostate cancer (PCa) outcomes. Studies using surrogate PCa end points suggest outcomes for Gleason score (GS) 7 cancers vary according to the predominance of pattern 4. These studies have influenced clinical practice, but it is unclear if rates of PCa mortality differ for 3 + 4 and 4 + 3 tumors. Using PCa mortality as the primary end point, we compared outcomes in Gleason 3 + 4 and 4 + 3 cancers, and the predictive ability of GS from a standardized review versus original scoring.Patients and Methods Three study pathologists conducted a blinded standardized review of 693 prostatectomy and 119 biopsy specimens to assign primary and secondary Gleason patterns. Tumor specimens were from PCa patients diagnosed between 1984 and 2004 from the Physicians' Health Study and Health Professionals Follow-Up Study. Lethal PCa (n = 53) was defined as development of bony metastases or PCa death. Hazard ratios (HR) were estimated according to original GS and standardized GS. We compared the discrimination of standardized and original grading with C-statistics from models of 10-year survival.Results For prostatectomy specimens, 4 + 3 cancers were associated with a three-fold increase in lethal PCa compared with 3 + 4 cancers (95% CI, 1.1 to 8.6). The discrimination of models of standardized scores from prostatectomy (C-statistic, 0.86) and biopsy (C-statistic, 0.85) were improved compared to models of original scores (prostatectomy C-statistic, 0.82; biopsy C-statistic, 0.72).Conclusion Ignoring the predominance of Gleason pattern 4 in GS 7 cancers may conceal important prognostic information. A standardized review of GS can improve prediction of PCa survival.