Comparing the Gleason prostate biopsy and Gleason prostatectomy grading system: The Lahey Clinic Medical Center experience and an international meta-analysis
Comparing the Gleason prostate biopsy and Gleason prostatectomy grading system: The Lahey Clinic Medical Center experience and an international meta-analysis
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DOI：
10.1016/j.eururo.2008.03.049
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发表时间：
2008-08-01
期刊：
影响因子：
23.4
通讯作者：
Libertino, John A.
中科院分区：
文献类型：
--
作者：
Cohen, Michael S.;Hanley, Robert S.;Libertino, John A.
背景：文献中前列腺活检格里森分级预测前列腺切除术格里森分级的准确性差异很大。目的：确定 LCMC（Lahey 诊所医疗中心）和全世界前列腺活检格里森分级和前列腺切除术格里森分级的准确性和分布。设计、设置和参与者：参与者包括 2890 名术前未接受激素治疗的患者，并且可获得术前和术后格里森总和。 1982 年至 2007 年间，参与者在学术转诊中心 LCMC 接受了根治性前列腺切除术。荟萃分析研究选自 Medline：1994-2007 年。搜索标准包括关键词“格里森”、“活检”和“前列腺切除术”，> = 200 名患者，以及活检和前列腺切除术的格里森评分是否属于预定义的格里森等级。荟萃分析包括 15 项研究和 LCMC 数据库，共有 14,839 名患者。测量：格里森评分 2-6、7 和 8-10 分别转换为低、中和高等级。计算敏感性、特异性、阳性预测值（PPV）和阴性预测值。 kappa统计和卡方用于比较活检和前列腺切除术分级。结果和局限性：前列腺切除术分级被准确预测、升级和降级的患者百分比在LCMC中分别为58%、36%和5%，在荟萃分析中分别为63%、30%和7%。 LCMC 中低、中、高级别癌症的 PPV 分别为 54%、70% 和 60%，荟萃分析中分别为 62%、70% 和 50%。 LCMC（91%、38%、28%）和荟萃分析（90%、40%、33%）的敏感性分别随着格里森等级（低、中和高）的增加而降低。活检中低、中、高级别癌症的分布（69%、25%和6%）和前列腺切除标本（47%、44%和9%）仅表现出“公平”一致性（kappa，0.37）。结论：患者和从业者需要认识到低级别疾病的显着升级和高级别疾病的降级。 (C) 2008 年欧洲泌尿外科协会。由 Elsevier B.V. 出版。保留所有权利。
Background: The accuracy of the prostate biopsy Gleason grade to predict the prostatectomy Gleason grade varies tremendously in the literature.Objectives: Determine the accuracy and distribution of the prostate biopsy Gleason grade and prostatectomy Gleason grade at LCMC (Lahey Clinic Medical Center) and worldwide.Design, Setting, and Participants: Participants included 2890 patients who had not received preoperative hormones, and for whom preoperative and postoperative Gleason sums were available. Participants underwent radical prostatectomy at LCMC, an academic referral center, from 1982-2007. Studies for the meta-analysis were selected from Medline: 1994-2007. Search criteria included keywords "Gleason," "biopsy," and "prostatectomy," >= 200 patients, and whether the biopsy and prostatectomy Gleason scores categorized into the predefined Gleason grades. The meta-analysis included 15 studies and the LCMC database for 14,839 total patients.Measurements: Gleason scores 2-6, 7, and 8-10 were converted to low, moderate, and high grade, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated. The kappa statistic and chi-square were used to compare biopsy and prostatectomy grades.Results and Limitations: The percentage of patients in whom the prostatectomy grade was accurately predicted, upgraded, and downgraded was 58%, 36%, and 5% at LCMC and 63%, 30%, and 7% in the meta-analysis, respectively. The PPV for low-, moderate-, and high-grade cancer was 54%, 70%, and 60% for LCMC and 62%, 70%, and 50% for the meta-analysis, respectively. The sensitivity decreased with increasing Gleason grade (low, moderate, and high) for LCMC (91%, 38%, 28%) and the meta-analysis (90%, 40%, 33%), respectively. The distribution of low-, moderate-, and high-grade cancer on biopsy (69%, 25%, and 6%) and prostatectomy specimen (47%, 44%, and 9%) demonstrated only "fair" agreement (kappa, 0.37).Conclusions: Patients and practitioners need to be cognizant of significant upgrading for low-grade disease and the downgrading for high-grade disease. (C) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.