Sengupta Shomik, Slezak Jeffrey M, Blute Michael L, Leibovich Bradley C, Sebo Thomas J, Myers Robert P, Cheville John C, Bergstralh Eric J, Zincke Horst
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Cancer. 2006 Jun 15;106(12):2630-5. doi: 10.1002/cncr.21924.
The objectives of the current study were to examine time trends in the prevalence of Gleason grades of prostate cancer on radical retropubic prostatectomy (RRP) specimens and to assess the resultant impact on prognosis.
The authors examined the prevalence over time of each grade and Gleason score (GS) on RRP specimens from 8750 patients who were treated between 1989 and 2001. Biochemical recurrence-free survival (BRFS), which was estimated by using Kaplan-Meier methodology, was examined in subgroups of patients defined by tumor grade and era of surgery.
The prevalence of Grade 3 prostate cancers increased (86% vs. 49% for primary Gleason grade and 71% vs. 47% for secondary Gleason grade; 1999-2001 vs. 1989-1990, respectively), whereas the prevalence of Grade 2 tumors decreased (0.4% vs. 38% for primary Gleason grade and 1.3% vs. 28% for secondary Gleason grade, respectively) over the study period, leading to fewer GS 4 and 5 tumors and more GS 6 and 7 tumors. BRFS improved over time for patients who had GS 5 tumors (hazards ratio [HR], 0.92 per year; P = .003) and GS 6 tumors (HR, 0.93; P < .001) but remained unchanged for GS 7 tumors (HR 0.99; P = .462) and GS 8-10 tumors (HR 1.02; P = .360). Patients who were treated in the recent era (1997-2001) had greater differentiation of BRFS based on GS or Gleason grade compared with patients who were treated earlier (1989-1991).
The current results confirmed that there were changes in the prevalence of Gleason grades on RRP specimens between 1989 and 2001. A chronological change in pathologic grading classification is suggested by evolving prognostic implications, which must be accounted for when comparing outcomes from different eras.
本研究的目的是研究耻骨后根治性前列腺切除术（RRP）标本中前列腺癌Gleason分级患病率的时间趋势，并评估其对预后的影响。
作者研究了1989年至2001年间接受治疗的8750例患者RRP标本中各分级和Gleason评分（GS）随时间的患病率。采用Kaplan-Meier方法估计生化无复发生存率（BRFS），并在根据肿瘤分级和手术时代定义的患者亚组中进行研究。
在研究期间，3级前列腺癌的患病率增加（主要Gleason分级中分别为86%对49%，次要Gleason分级中分别为71%对47%；分别为1999 - 2001年对1989 - 1990年），而2级肿瘤的患病率下降（主要Gleason分级中分别为0.4%对38%，次要Gleason分级中分别为1.3%对28%），导致GS 4和5级肿瘤减少，GS 6和7级肿瘤增多。GS 5级肿瘤患者（风险比[HR]，每年0.92；P = 0.003）和GS 6级肿瘤患者（HR，0.93；P < 0.001）的BRFS随时间改善，但GS 7级肿瘤患者（HR 0.99；P = 0.462）和GS 8 - 10级肿瘤患者（HR 1.02；P = 0.360）的BRFS保持不变。与早期（1989 - 1991年）接受治疗的患者相比，近期（1997 - 2001年）接受治疗的患者基于GS或Gleason分级的BRFS差异更大。
当前结果证实1989年至2001年间RRP标本中Gleason分级的患病率发生了变化。预后意义的演变提示了病理分级分类的时间变化，在比较不同时代的结果时必须考虑这一点。
