Significance of tertiary gleason pattern 5 in gleason score 7 radical prostatectomy specimens
Significance of tertiary gleason pattern 5 in gleason score 7 radical prostatectomy specimens
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DOI：
10.1016/j.juro.2007.09.085
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发表时间：
2008-02-01
影响因子：
6.6
通讯作者：
Sexton, Wade J.
中科院分区：
文献类型：
--
作者：
Whittemore, Darren E.;Hick, Eric J.;Sexton, Wade J.
目的：报告前列腺癌的Gleason分级系统解释了原发性和继发性Gleason模式。高三尖瓣环的临床意义材料和方法：300例Gleason评分为7分的患者的根治性乳腺癌切除术标本（3 + 4或4 + 3）前列腺癌的病理学复查存在的第三级5级模式，以及与病理分期和生化无复发生存的关联。共有214例患者符合研究入选标准。Gleason评分为7分和第三级5级癌症的患者比Gleason评分为7分而没有第三级5级癌症的患者具有显著更高的病理分期疾病（p < 0.001）。与Gleason评分7的肿瘤相比，Gleason评分7 +三级模式5的肿瘤与不利的病理学特征如精囊浸润、前列腺外延伸和淋巴血管浸润显著相关（p < 0.05）。对于Gleason评分为7的肿瘤，具有较低原发性Gleason模式3的三级5级组分对分析的所有病理学参数的相对影响大于具有较高原发性Gleason模式4的三级5级组分。与Gleason评分7肿瘤患者（121个月）相比，Gleason评分7 +三级模式5肿瘤患者的生化无复发生存期（54个月）显著降低（p = 0.0005）。术前前列腺特异性抗原，淋巴管浸润和积极的手术切缘状态被证明是独立的预测前列腺特异性抗原复发的多变量analysis.Conclusions：小百分比的三级5模式Gleason评分7根治性前列腺切除术标本与侵略性的病理特征预测先进的病理阶段和生化复发无生存。
Purpose: The Gleason grading system in reporting prostate cancer accounts for the primary and secondary Gleason pattern. The clinical significance of a higher tertiary (third most prevalent) grade is largely unrecognized.Materials and Methods: Radical prostatectomy specimens from 300 patients with Gleason score 7 (3 + 4 or 4 + 3) prostate cancer were pathologically reexamined for the presence of a tertiary grade 5 pattern as well as the association with pathological stage and biochemical recurrence-free survival.Results: A total of 214 patients met study inclusion criteria. Patients with Gleason score 7 and tertiary grade 5 cancer had significantly higher pathological stage disease than patients with Gleason score 7 without tertiary grade 5 cancer (p < 0.001). Gleason score 7 + tertiary pattern 5 tumors were significantly associated with adverse pathological features such as seminal vesicle invasion, extraprostatic extension and lymphovascular invasion compared to Gleason score 7 tumors (p < 0.05). The relative effects of a tertiary grade 5 component on all pathological parameters analyzed was greater for Gleason score 7 tumors with a lower primary Gleason pattern 3 vs a higher primary Gleason pattern 4. Patients with Gleason score 7 + tertiary pattern 5 tumors had significantly decreased biochemical recurrence-free survival (54 months) compared to patients with Gleason score 7 tumors (121 months) (p = 0.0005). Preoperative prostate specific antigen, lymphovascular invasion and positive surgical margin status were shown to be independent predictors of prostate specific antigen recurrence on multivariate analysis.Conclusions: Small percentages of tertiary grade 5 patterns in Gleason score 7 radical prostatectomy specimens are associated with aggressive pathological features predictive of advanced pathological stage and biochemical recurrence-free survival.