A Contemporary Prostate Cancer Grading System: A Validated Alternative to the Gleason Score.
A Contemporary Prostate Cancer Grading System: A Validated Alternative to the Gleason Score.
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DOI：
10.1016/j.eururo.2015.06.046
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发表时间：
2016-03
期刊：
影响因子：
23.4
通讯作者：
Klein, Eric A.
中科院分区：
文献类型：
--
作者：
Epstein, Jonathan I.;Zelefsky, Michael J.;Sjoberg, Daniel D.;Nelson, Joel B.;Egevad, Lars;Magi-Galluzzi, Cristina;Vickers, Andrew J.;Parwani, Anil V.;Reuter, Victor E.;Fine, Samson W.;Eastham, James A.;Wiklund, Peter;Han, Misop;Reddy, Chandana A.;Ciezki, Jay P.;Nyberg, Tommy;Klein, Eric A.
尽管在2005年和2014年进行了修订，但格里森前列腺癌（PCa）分级系统仍然存在重大缺陷。将Gleason评分组合成三层分组（6、7、8-10）最常用于预后和治疗目的。最低分，分配为6，可能被误解为分级量表中间的癌症，3 + 4 = 7和4 + 3 = 7通常被认为是相同的预后组。使用多机构和多模式治疗数据，验证新的分级系统准确地产生较少数量的等级，具有最显著的预后差异。在2005年至2014年期间，有20845名男性在五个学术机构接受了根治性乳房切除术; 5501名男性在两个学术机构接受了放射治疗。结果基于生化复发（BCR）。对数秩检验通过Gleason评分评估BCR的单变量差异。单独的单变量和多变量考克斯比例风险使用了四种可能的Gleason评分分类。在手术队列中，我们发现格里森3 + 4与4 + 3以及格里森8与9之间的复发率存在很大差异。对于Gleason评分3 + 4、4 + 3、8和9-10，相对于Gleason评分6的风险比分别为1.9、5.1、8.0和11.7。这些差异在放疗队列中作为一个整体被减弱，因为高级别疾病患者的辅助或新辅助激素增加，但在仅接受放疗的患者中明显可见。一个五年级组系统有最高的预后歧视所有队列的单变量和多变量分析。主要局限性是不可避免地使用前列腺特异性抗原BCR作为终点，而不是癌症相关死亡。新的PCa分级系统具有以下优点：比当前系统更准确的等级分层，简化的五级分级系统，最低等级为1，而不是6，有可能减少PCa的过度治疗。我们研究了用根治性前列腺切除术或放射治疗治疗的前列腺癌（PCa）的结果，并验证了一种新的分级系统，该系统比现有系统具有更准确的分级分层，包括一个简化的五级分级系统，最低等级为1，而不是6，有可能减少PCa的过度治疗。
Despite revisions in 2005 and 2014, the Gleason prostate cancer (PCa) grading system still has major deficiencies. Combining of Gleason scores into a three-tiered grouping (6, 7, 8–10) is used most frequently for prognostic and therapeutic purposes. The lowest score, assigned 6, may be misunderstood as a cancer in the middle of the grading scale, and 3 + 4 = 7 and 4 + 3 = 7 are often considered the same prognostic group. To verify that a new grading system accurately produces a smaller number of grades with the most significant prognostic differences, using multi-institutional and multimodal therapy data. Between 2005 and 2014, 20 845 consecutive men were treated by radical prostatectomy at five academic institutions; 5501 men were treated with radiotherapy at two academic institutions. Outcome was based on biochemical recurrence (BCR). The log-rank test assessed univariable differences in BCR by Gleason score. Separate univariable and multivariable Cox proportional hazards used four possible categorizations of Gleason scores. In the surgery cohort, we found large differences in recurrence rates between both Gleason 3 + 4 versus 4 + 3 and Gleason 8 versus 9. The hazard ratios relative to Gleason score 6 were 1.9, 5.1, 8.0, and 11.7 for Gleason scores 3 + 4, 4 + 3, 8, and 9–10, respectively. These differences were attenuated in the radiotherapy cohort as a whole due to increased adjuvant or neoadjuvant hormones for patients with high-grade disease but were clearly seen in patients undergoing radiotherapy only. A five–grade group system had the highest prognostic discrimination for all cohorts on both univariable and multivariable analysis. The major limitation was the unavoidable use of prostate-specific antigen BCR as an end point as opposed to cancer-related death. The new PCa grading system has these benefits: more accurate grade stratification than current systems, simplified grading system of five grades, and lowest grade is 1, as opposed to 6, with the potential to reduce overtreatment of PCa. We looked at outcomes for prostate cancer (PCa) treated with radical prostatectomy or radiation therapy and validated a new grading system with more accurate grade stratification than current systems, including a simplified grading system of five grades and a lowest grade is 1, as opposed to 6, with the potential to reduce overtreatment of PCa.
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DOI：
10.1097/pas.0b013e3182556dcd
发表时间：
2012-09
期刊：
The American journal of surgical pathology
影响因子：
--
作者：
Ross HM;Kryvenko ON;Cowan JE;Simko JP;Wheeler TM;Epstein JI
通讯作者：
Epstein JI
DOI：
10.1056/nejmoa1311593
发表时间：
2014-03-06
期刊：
The New England journal of medicine
影响因子：
--
作者：
Bill-Axelson A;Holmberg L;Garmo H;Rider JR;Taari K;Busch C;Nordling S;Häggman M;Andersson SO;Spångberg A;Andrén O;Palmgren J;Steineck G;Adami HO;Johansson JE
通讯作者：
Johansson JE
影响因子：
4.5
作者：
Pierorazio PM;Walsh PC;Partin AW;Epstein JI
通讯作者：
Epstein JI
DOI：
10.1056/nejmoa1209978
发表时间：
2013-01-31
期刊：
The New England journal of medicine
影响因子：
--
作者：
Resnick MJ;Koyama T;Fan KH;Albertsen PC;Goodman M;Hamilton AS;Hoffman RM;Potosky AL;Stanford JL;Stroup AM;Van Horn RL;Penson DF
通讯作者：
Penson DF
DOI：
10.1056/nejmoa1113162
发表时间：
2012-07-19
期刊：
The New England journal of medicine
影响因子：
--
作者：
Wilt TJ;Brawer MK;Jones KM;Barry MJ;Aronson WJ;Fox S;Gingrich JR;Wei JT;Gilhooly P;Grob BM;Nsouli I;Iyer P;Cartagena R;Snider G;Roehrborn C;Sharifi R;Blank W;Pandya P;Andriole GL;Culkin D;Wheeler T;Prostate Cancer Intervention versus Observation Trial (PIVOT) Study Group
通讯作者：
Prostate Cancer Intervention versus Observation Trial (PIVOT) Study Group