Grading of Prostate Cancer: Past, Present, and Future
Grading of Prostate Cancer: Past, Present, and Future
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DOI：
10.1007/s11934-016-0576-4
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发表时间：
2016-03-01
影响因子：
2.6
通讯作者：
Epstein, Jonathan I.
中科院分区：
文献类型：
--
作者：
Matoso, Andres;Epstein, Jonathan I.
自20世纪70年代采用Gleason分级系统以来，前列腺癌的分级发生了重大变化。Gleason模式1和2不再使用，目前的Gleason评分6/10是可能的最低等级。历史上被认为是格里森3级的几种特定形态目前被指定为格里森模式4。因此，目前格里森评分为6的癌症比历史上的癌症有更好的预后。现在有大量文献支持Gleason评分7包括预后非常不同的患者; Gleason评分3+ 4的患者比Gleason评分4 + 3的患者预后好得多。在高级别癌症患者中，现在也很清楚，Gleason评分为8的患者的预后明显优于Gleason评分为9-10的男性。此外，最近的研究表明，Gleason评分为9或10的患者的预后没有显著差异，这使得两者之间的区别毫无意义。提出了一种新的现代分级系统，解决了这些变化/问题，并提供了一个更简单的系统，只有五个等级，更准确地反映了每个群体的预后。我们回顾了格里森评分系统的不同变化，因为它的概念，以及导致一个新的当代分级系统的研究。
The grading of prostate cancer has undergone significant changes since the adoption of the Gleason grading system in the 1970s. Gleason patterns 1 and 2 are no longer in use and the current Gleason score 6 of 10 is the lowest grade possible. Several specific morphologies that were historically considered Gleason grade 3 are currently assigned a Gleason pattern 4. Consequently, current Gleason score 6 cancers have a better prognosis than historic ones. There is now ample literature that supports that Gleason score 7 includes patients with very different prognosis; those with Gleason score 3+ 4 have a much better prognosis than patients with Gleason score 4 + 3. Within patients with high-grade cancer, it is now also clear that patients with Gleason score 8 have a significantly better prognosis than men with Gleason scores 9-10. Additionally, more recent studies have demonstrated that there is no significant difference in the prognosis of patients with Gleason score 9 or 10, making the distinction between the two pointless. A new contemporary grading system has been proposed that addresses these changes/problems and provides a simpler system with only five grades that reflect more accurately the prognosis of each group. We review the different changes applied to the Gleason scoring system since its conception as well as the studies leading to a new contemporary grading system.