The prognostic significance of tertiary Gleason pattern 5 in radical prostatectomy specimens
The prognostic significance of tertiary Gleason pattern 5 in radical prostatectomy specimens
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DOI：
10.1097/00000478-200403000-00014
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发表时间：
2004-03-01
影响因子：
5.6
通讯作者：
Epstein, JI
中科院分区：
文献类型：
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作者：
Mosse, CA;Magi-Galluzzi, C;Epstein, JI
在前列腺癌的格里森分级系统中，尽管可能存在第三种（三级）模式等级，但仅报告了两种最普遍的模式。我们将 227 例具有三级模式 5 的根治性前列腺切除术的病理分期与 604 例缺乏三级组成部分的根治性前列腺切除术的病理分期进行了比较。具有三级模式为 5 的 Gleason 评分 3 + 4 肿瘤比那些没有三级成分的 Gleason 评分 3 + 4 肿瘤（P = 0.012）并且处于与 Gleason 评分 3 + 5 肿瘤相似的阶段的肿瘤更有可能出现更高阶段的疾病。三级模式为 5 的 Gleason 评分 4 + 3 肿瘤比 Gleason 评分 4 + 3 肿瘤更不可能局限于器官（P = 0.02），并且比 Gleason 评分 4 + 4 肿瘤更不可能出现淋巴结转移（P = 0.027）。然而，具有三级模式 5 的格里森评分 4 + 4 与格里森评分 4 + 4 的肿瘤无法区分。当初级和次级阶段较低时，5 的第三级模式的相对影响最大，但会被高级初级和次级模式已经具有攻击性的性质所掩盖。因此，除了非常高级的肿瘤外，在根治性前列腺切除术中应报告前列腺腺癌的三级评分，因为它具有预后意义。
In the Gleason grading system for prostatic cancer only the two most prevalent patterns are reported, although a third (tertiary) pattern grade may be present. We compared the pathologic stage of 227 radical prostatectomies with tertiary pattern 5 to the pathologic stage of 604 radical prostatectomies lacking a tertiary component. Gleason score 3 + 4 tumors with a tertiary pattern of 5 were more likely to present with higher stage disease than those Gleason score 3 + 4 tumors without a tertiary component (P = 0.012) and at a stage similar to Gleason score 3 + 5 tumors. Gleason score 4 + 3 tumors with a tertiary pattern of 5 were less likely to be organ-confined than Gleason score 4 + 3 tumors (P = 0.02) and less likely to have lymph node metastases than Gleason score 4 + 4 tumors (P = 0.027). However, Gleason score 4 + 4 with a tertiary pattern of 5 were indistinguishable from Gleason score 4 + 4 tumors. The relative effects of a tertiary pattern of 5 were greatest when the primary and secondary stages were low but become obscured by the already aggressive nature of advanced primary and secondary patterns. Therefore, except for very high-grade tumors, tertiary scoring of prostatic adenocarcinoma at radical prostatectomy should be reported as it has prognostic significance.