Gleason Score 7 Prostate Cancer on Needle Biopsy: Relation of Primary Pattern 3 or 4 to Pathological Stage and Progression After Radical Prostatectomy
Gleason Score 7 Prostate Cancer on Needle Biopsy: Relation of Primary Pattern 3 or 4 to Pathological Stage and Progression After Radical Prostatectomy
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DOI：
10.1016/j.juro.2011.05.075
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发表时间：
2011-10-01
影响因子：
6.6
通讯作者：
Epstein, Jonathan I.
中科院分区：
文献类型：
--
作者：
Amin, Ali;Partin, Alan;Epstein, Jonathan I.
目的：只有少数相互矛盾的出版物评估了在预测病理分期和生化复发方面，活检材料的Gleason评分4 + 3 = 7是否比3 + 4 = 7具有更差的预后。较早的研究早于2005年建立的改良格里森分级系统的使用。材料和方法：我们回顾性研究了1，791例前列腺活检格里森评分为7的病例，以确定格里森评分7分为3 + 4与4 + 3是否具有预后意义在现代时代。结果：在Gleason评分3 + 4 = 7和Gleason评分4 + 3 = 7之间，患者年龄、术前血清前列腺特异性抗原、每个核心的最大肿瘤百分比或阳性核心数量没有差异。Gleason评分4 + 3 = 7显示了与病理分期的总体相关性（器官局限性、局灶性前列腺外扩展、非局灶性前列腺外扩展、精囊浸润/淋巴结转移，p = 0.005）。在多变量分析中，Gleason评分4 + 3 = 7（p = 0.03）、阳性核心数（p = 0.002）、每个核心的最大癌症百分比（p = 0.006）和术前血清前列腺特异性抗原（p = 0.03）均与病理分期相关。活检Gleason评分4 + 3 = 7也与根治性膀胱切除术后生化进展风险增加相关（p = 0.0001）。多变量分析Gleason评分4 + 3 = 7（p = 0.001），每个核心的最大癌症百分比（P < 0.0001）和术前血清前列腺特异性抗原（p < 0.0001）但阳性核心数与根治性乳腺癌切除术后生化进展风险无关。我们的研究进一步表明，Gleason评分7不应被视为一个同质组的疾病管理和预后的目的。
Purpose: There have been only a few contradictory publications assessing whether Gleason score 4 + 3 = 7 has a worse prognosis than 3 + 4 = 7 on biopsy material in predicting pathological stage and biochemical recurrence. Older studies predated the use of the modified Gleason grading system established in 2005.Materials and Methods: We retrospectively studied 1,791 cases of Gleason score 7 on prostatic biopsy to determine whether the breakdown of Gleason score 7 into 3 + 4 vs 4 + 3 has prognostic significance in the modern era.Results: There was no difference in patient age, preoperative serum prostate specific antigen, maximum tumor percent per core or the number of positive cores between Gleason score 3 + 4 = 7 and Gleason score 4 + 3 = 7. Gleason score 4 + 3 = 7 showed an overall correlation with pathological stage (organ confined, focal extraprostatic extension, nonfocal extraprostatic extension, seminal vesicle invasion/lymph node metastases, p = 0.005). On multivariate analysis Gleason score 4 + 3 = 7 (p = 0.03), number of positive cores (p = 0.002), maximum percent of cancer per core (p = 0.006) and preoperative serum prostate specific antigen (p = 0.03) all correlated with pathological stage. Gleason score 4 + 3 = 7 on biopsy was also associated with an increased risk of biochemical progression after radical prostatectomy (p = 0.0001). On multivariate analysis Gleason score 4 + 3 = 7 (p = 0.001), maximum percent of cancer per core (p < 0.0001) and preoperative serum prostate specific antigen (p < 0.0001) but not number of positive cores correlated with the risk of biochemical progression after radical prostatectomy.Conclusions: Our study further demonstrates that Gleason score 7 should not be considered a homogenous group for the purposes of disease management and prognosis.