Humphrey Peter A
Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA.
Mod Pathol. 2004 Mar;17(3):292-306. doi: 10.1038/modpathol.3800054.
Gleason grade of adenocarcinoma of the prostate is an established prognostic indicator that has stood the test of time. The Gleason grading method was devised in the 1960s and 1970s by Dr Donald F Gleason and members of the Veterans Administration Cooperative Urological Research Group. This grading system is based entirely on the histologic pattern of arrangement of carcinoma cells in H&E-stained sections. Five basic grade patterns are used to generate a histologic score, which can range from 2 to 10. These patterns are illustrated in a standard drawing that can be employed as a guide for recognition of the specific Gleason grades. Increasing Gleason grade is directly related to a number of histopathologic end points, including tumor size, margin status, and pathologic stage. Indeed, models have been developed that allow for pretreatment prediction of pathologic stage based upon needle biopsy Gleason grade, total serum prostate-specific antigen level, and clinical stage. Gleason grade has been linked to a number of clinical end points, including clinical stage, progression to metastatic disease, and survival. Gleason grade is often incorporated into nomograms used to predict response to a specific therapy, such as radiotherapy or surgery. Needle biopsy Gleason grade is routinely used to plan patient management and is also often one of the criteria for eligibility for clinical trials testing new therapies. Gleason grade should be routinely reported for adenocarcinoma of the prostate in all types of tissue samples. Experimental approaches that could be of importance in the future include determination of percentage of high-grade Gleason pattern 4 or 5, and utilization of markers discovered by gene expression profiling or by genetic testing for DNA abnormalities. Such markers would be of prognostic usefulness if they provided added value beyond the established indicators of Gleason grade, serum prostate-specific antigen, and stage. Currently, established prognostic factors for prostatic carcinoma recommended for routine reporting are TNM stage, surgical margin status, serum prostate-specific antigen, and Gleason grade.
前列腺腺癌的Gleason分级是一个经过时间考验的既定预后指标。Gleason分级方法是由唐纳德·F·格里森博士和退伍军人管理局合作泌尿学研究小组的成员在20世纪60年代和70年代设计的。该分级系统完全基于苏木精-伊红染色切片中癌细胞的组织学排列模式。使用五种基本分级模式来生成一个组织学评分，范围可以从2到10。这些模式在一张标准图中展示，可作为识别特定Gleason分级的指南。Gleason分级的增加与许多组织病理学终点直接相关，包括肿瘤大小、切缘状态和病理分期。事实上，已经开发出模型，能够根据穿刺活检Gleason分级、血清总前列腺特异性抗原水平和临床分期对病理分期进行治疗前预测。Gleason分级与许多临床终点相关，包括临床分期、进展为转移性疾病和生存率。Gleason分级经常被纳入用于预测对特定治疗（如放疗或手术）反应的列线图中。穿刺活检Gleason分级通常用于规划患者管理，也是新疗法临床试验资格标准之一。对于所有类型的组织样本中的前列腺腺癌，都应常规报告Gleason分级。未来可能重要的实验方法包括确定高级别Gleason模式4或5的百分比，以及利用通过基因表达谱分析或DNA异常基因检测发现的标志物。如果这些标志物能提供超过既定的Gleason分级、血清前列腺特异性抗原和分期指标的附加价值，那么它们将具有预后意义。目前，推荐常规报告的前列腺癌既定预后因素是TNM分期、手术切缘状态、血清前列腺特异性抗原和Gleason分级。
