The impact of the 2005 International Society of Urological Pathology consensus conference on standard Gleason grading of prostatic carcinoma in needle biopsies
The impact of the 2005 International Society of Urological Pathology consensus conference on standard Gleason grading of prostatic carcinoma in needle biopsies
复制标题
DOI：
10.1016/j.juro.2008.04.018
复制
发表时间：
2008-08-01
影响因子：
6.6
通讯作者：
Ferreira, Ubirajara
中科院分区：
文献类型：
--
作者：
Billis, Athanase;Guimaraes, Marbele S.;Ferreira, Ubirajara
目的：在2005年国际泌尿病理学会共识会议上，前列腺癌的格里森分级系统进行了首次重大修订。我们比较了传统的和改良的Gleason分级的模式和预后组的变化的一致性，并检查了改良的Gleason grading.Materials和方法的判别力：分级是基于172前列腺穿刺活检的患者随后接受根治性前列腺切除术。考虑四个预后Gleason分级组，分为2-4、5-6、7和8-10分。为了检查改良的Gleason分级的区分能力，我们比较了生化检查的时间，根据标准分级和修订分级之间的预后组，评估前列腺特异性抗原（PSA）无进展结局。国际泌尿病理学会对Gleason分级的共识建议的最大影响是在次要模式上，其一致性百分比最低，并反映在向较高的Gleason预后组。在172例仅根据共识标准改变Gleason预后组（更高级别）的患者中，46例（26.7%）术前前列腺特异性抗原更高，肿瘤更广泛，手术切缘阳性，病理分期更高。修订后的Gleason分级在该系列研究中发现，Gleason评分为8-10分的积极预后组中，有更多患者在根治性乳腺癌切除术后达到生化无进展结局的时间显著缩短（对数秩p = 0.011）。这项研究的结果表明，国际泌尿病理学会的建议是一个有价值的完善标准格里森评分系统
Purpose: At an International Society of Urological Pathology consensus conference in 2005 the Gleason grading system for prostatic carcinoma underwent its first major revision. We compared the concordance of pattern and change of prognostic groups for the conventional and the modified Gleason grading, and checked the discriminative power of the modified Gleason grading.Materials and Methods: The grading was based on 172 prostatic needle biopsies of patients subsequently undergoing radical prostatectomy. Four prognostic Gleason grading groups were considered, divided into scores of 2-4, 5-6, 7 and 8-10. To check the discriminative power of the modified Gleason grading we compared the time of biochemical (prostate specific antigen) progression-free outcome according to prognostic groups between standard and revised grading.Results: The greatest impact of the International Society of Urological Pathology consensus recommendations for Gleason grading was seen on the secondary pattern which had the lowest percentage of concordance and was reflected in a change toward higher Gleason prognostic groups. Of 172 patients in whom the Gleason prognostic group was changed (to higher grades) based solely on the consensus criteria, 46 (26.7%) had higher preoperative prostate specific antigen, more extensive tumors and positive surgical margins, and higher pathological stage. The revised Gleason grading identified in this series a higher number of patients in the aggressive prognostic group Gleason score 8-10 who had a significantly shorter time to biochemical progression-free outcome after radical prostatectomy (log rank p = 0.011).Conclusions: The findings of this study indicate that the recommendations of the International Society of Urological Pathology are a valuable refinement of the standard Gleason grading system.