Do adenocarcinomas of the prostate with Gleason score (GS) ≤6 have the potential to metastasize to lymph nodes?
Do adenocarcinomas of the prostate with Gleason score (GS) ≤6 have the potential to metastasize to lymph nodes?
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DOI：
10.1097/pas.0b013e3182556dcd
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发表时间：
2012-09
期刊：
影响因子：
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通讯作者：
Epstein JI
中科院分区：
文献类型：
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作者：
Ross HM;Kryvenko ON;Cowan JE;Simko JP;Wheeler TM;Epstein JI
尽管很少见，但在报告的一系列根治性前列腺切除术中，GS≤6的男性中有盆腔淋巴结（LN）转移的病例。然而，没有研究表明，盆腔淋巴结转移是否发生在肿瘤GS≤6使用国际泌尿病理学会（ISUP）更新的格里森评分系统。我们在4个大型学术中心的根治性直肠癌切除术数据库中检索GS≤6的病例。仅纳入提交并完全包埋盆腔淋巴结清扫的盆腔切除术。总共确定了14，123例病例，其中22例LN阳性。19例病例的组织学审查（3例病例无法进行审查）显示，所有病例的等级均高于病理学家最初报告的等级。在17例ISUP前审查的病例中，2例升级为4+3=7，同时伴有筛状和不良形成的腺体。1例升级为4+3=7，第三型5，显示筛状腺，腺体不成形，单细胞索。11例病例升级为3+4=7，具有肾小球样结构和小至大的筛状腺体（其中1例还具有导管腺癌特征）。2例第三型4伴小筛状腺。1例病例有明显的胶体成分，由于大筛状腺和粘蛋白内的固体细胞片，目前将其分级为4+5=9。在2例ISUP术后病例中，1例显示三级模式4，另1例显示Gleason评分3+4=7，伴不规则筛状腺。分级过低主要是GS ≤6的LN阳性的原因，自2005年采用ISUP分级系统以来，GS ≤6的LN阳性显著下降。在来自多个机构的14，000多例完全包埋的RP中，没有一例GS≤6肿瘤伴LN转移。与普遍的假设相反，Gleason评分≤6的肿瘤似乎不会转移到淋巴结。相反，格里森模式4或5，更好地定义了目前的ISUP更新的分级系统，是转移性疾病所必需的。
Although rare, there are cases within reported series of men with GS≤6 in radical prostatectomies that have pelvic lymph node (LN) metastases. However, there are no studies as to whether pelvic LN metastases occur in tumors GS≤6 using the International Society of Urological Pathology (ISUP) updated Gleason scoring system. We performed a search of the radical prostatectomy databases at 4 large academic centers for cases of GS≤6. Only prostatectomies submitted and embedded in entirety with pelvic lymph node dissections were included. A combined total of 14,123 cases were identified out of which 22 cases had a positive LN. Histopathology review of 19 cases (3 cases unavailable for review) showed higher grade than originally reported by the pathologists in all cases. Of the 17 pre-ISUP reviewed cases, 2 were upgraded to 4+3=7 with both cribriform and poorly formed glands. One case was upgraded to 4+3=7 with tertiary pattern five displaying cribriform glands, poorly formed glands, and cords of single cells. Eleven cases were upgraded to 3+4=7 with glomeruloid structures and small to large cribriform glands (1 of these also had ductal adenocarcinoma features). Two cases had tertiary pattern 4 with small cribriform glands. One case had a prominent colloid component that would currently be graded as 4+5=9 due to large cribriform glands and solid sheets of cells within mucin. Of the two post-ISUP cases, one demonstrated tertiary pattern 4 and the other showed Gleason score 3+4=7 with irregular cribriform glands. Under-grading primarily accounts for LN positivity with GS ≤6, which has decreased significantly since the adoption of the ISUP grading system in 2005. Out of over 14,000 totally embedded RPs from multiple institutions, there was not a single case of a GS≤6 tumor with LN metastases. In contrast to prevailing assumptions, Gleason score ≤6 tumors do not appear to metastasize to lymph nodes. Rather, Gleason patterns 4 or 5, as better defined by the current ISUP updated grading system, is required for metastatic disease.