Grading prostate cancer.
Grading prostate cancer.
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发表时间：
1994-10
影响因子：
3.5
通讯作者：
D. Bostwick
中科院分区：
文献类型：
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作者：
D. Bostwick
组织学肿瘤分级是前列腺癌患者预后的一个强有力的预测因素。所有现有的分级系统都成功地识别了进展缓慢的高分化癌症和进展迅速的低分化癌症，但它们在细分具有中等恶性潜力的大多数中度分化癌症方面不太成功。Gleason系统，事实上的分级标准，通过腺体分化的程度来识别组织学模式，而不依赖于形态发生或组织发生模型;它通过将原发和继发模式结合到癌症评分中来反映肿瘤的异质性。已经提出的格里森分级的修改包括形态学核分级，分级分组，估计高级别癌症的数量（格里森模式4和5），并包括筛状模式作为格里森模式4而不是3。前列腺癌的大多数变体是高级别的（Gleason模式4和5），包括小细胞未分化癌、印戒细胞癌、肉瘤样癌和癌肉瘤。格里森系统可以被大多数研究者复制，尽管观察者之间和观察者内部存在不可避免的小而显著的差异。与匹配的直肠癌切除术标本相比，当代18号针芯活检低估了33%至45%的病例的肿瘤分级，高估了4%至32%的病例的分级，与传统14号活检的结果相似。分级错误在具有少量肿瘤和低级别肿瘤的活检标本中是常见的，并且可能是由于组织采样错误和肿瘤异质性。前列腺癌的升级可能发生在放射治疗后，但在雄激素剥夺治疗后很常见。前列腺癌预后的单变量和多变量分析几乎总是将癌症分级确定为患者预后的最重要预测因素之一。癌症分级与其他预后变量相结合，以创建一个多预后指数，应允许更精确地预测个别患者的结果。
Histologic tumor grade is a strong predictor of outcome for men with prostate cancer. All existing grading systems successfully identify well-differentiated cancer, which progresses slowly, and poorly differentiated cancer, which progresses rapidly, but they are less successful in subdividing most moderately differentiated cancers, which have an intermediate malignant potential. The Gleason system, the de facto standard for grading, identifies histologic patterns by the degree of glandular differentiation without relying on morphogenetic or histogenetic models; it reflects tumor heterogeneity by combining primary and secondary patterns into a cancer score. Modifications that have been proposed for Gleason grading include morphometric nuclear grading, grouping of grades, estimating the amount of high-grade cancer (Gleason patterns 4 and 5), and including the cribriform pattern as Gleason pattern 4 rather than 3. Most variants of prostate cancer are high grade (Gleason patterns 4 and 5), including small cell undifferentiated carcinoma, signet ring cell carcinoma, sarcomatoid carcinoma, and carcinosarcoma. The Gleason system can be reproduced by most investigators, although there is a small but significant level of interobserver and intraobserver variability that is unavoidable. When compared with matched prostatectomy specimens, contemporary 18-gauge needle core biopsy underestimates tumor grade in 33% to 45% of cases and overestimates grade in 4% to 32% of cases, similar to results with traditional 14-gauge biopsies. Grading errors are common in biopsy specimens with small amounts of tumor and low-grade tumor, and are probably due to tissue sampling error and tumor heterogeneity. Upgrading of prostate cancer may occur after radiation therapy but is common after androgen-deprivation therapy. Univariate and multivariate analyses of prognosis in prostate cancer almost always identify cancer grade as one of the most significant predictors of patient outcome. The combination of cancer grade with other prognostic variables to create a multiple prognostic index should allow greater precision in predicting outcome for individual patients.