Patel Abhijit A, Chen Ming-Hui, Renshaw Andrew A, D'Amico Anthony V
Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA.
JAMA. 2007 Oct 3;298(13):1533-8. doi: 10.1001/jama.298.13.1533.
In 2005, the International Society of Urologic Pathology consensus conference recommended that men with biopsy Gleason score 3 + 4 or 4 + 3 prostate cancer and tertiary pattern 5 should have their cancer classified as Gleason score 8 or 9, respectively. Yet, the management of men with Gleason score 7 vs 8 or 9 prostate cancer differs.
To compare the prognostic significance of Gleason score 7 with tertiary grade 5 vs other Gleason scores with respect to time to prostate-specific antigen (PSA) failure in men with prostate cancer.
DESIGN, SETTING, AND PATIENTS: From 1989 to 2005, 2370 men with clinical tumor category 1c to 3b, node-negative, and nonmetastatic prostate cancer underwent definitive therapy with surgery or radiation therapy with or without hormonal therapy. A pathologist with expertise in genitourinary cancers assigned Gleason scores to the prostate needle biopsy specimens. Cox regression was used to assess whether a significant association existed between the presence of tertiary grade 5 in men with Gleason score 7 disease and time to recurrence compared with men with Gleason score 7 without tertiary grade 5, Gleason score 5 to 6, or 8 to 10 disease, adjusting for known prognostic factors and treatment.
Time to PSA failure.
Men with Gleason score 7 and tertiary grade 5 disease had a significantly shorter time to PSA failure than men with 7 without tertiary grade 5 (median time, 5.0 vs 6.7 years, respectively; adjusted hazard ratio (HR), 0.56; 95% confidence interval [CI], 0.32-0.97; P = .04) or score of 6 or less (median time, 15.4 years; adjusted HR, 0.24; 95% CI, 0.13-0.43; P < .001). However, a significant difference was not observed when these men were compared with men with Gleason score 8 to 10 disease (median time, 5.1 years; adjusted HR, 0.96; 95% CI, 0.54-1.71; P = .90).
In this study population, men with prostate cancer having biopsy Gleason score 7 and tertiary grade 5 had a higher risk of PSA-failure when compared with men with Gleason score 7 without tertiary grade 5 and had a comparable risk with men with Gleason score 8 to 10.
2005年，国际泌尿病理学会共识会议建议，前列腺穿刺活检Gleason评分3 + 4或4 + 3且三级模式为5的男性，其癌症应分别归类为Gleason评分8或9。然而，Gleason评分为7的男性与评分为8或9的前列腺癌男性的治疗方法有所不同。
比较前列腺癌男性中，Gleason评分为7且三级分级为5与其他Gleason评分在前列腺特异性抗原（PSA）失败时间方面的预后意义。
设计、地点和患者：1989年至2005年，2370例临床肿瘤分期为1c至3b、淋巴结阴性且无转移的前列腺癌男性接受了手术或放疗（有无激素治疗）的确定性治疗。一位擅长泌尿生殖系统癌症的病理学家对前列腺穿刺活检标本进行Gleason评分。采用Cox回归分析，在调整已知预后因素和治疗的情况下，评估Gleason评分为7且存在三级分级5的男性与Gleason评分为7但无三级分级5、Gleason评分为5至6或8至10的男性相比，其三级分级5的存在与复发时间之间是否存在显著关联。
PSA失败时间。
Gleason评分为7且三级分级为5的男性与Gleason评分为7但无三级分级5的男性相比，PSA失败时间显著缩短（中位时间分别为5.0年和6.7年；调整后风险比[HR]为0.56；95%置信区间[CI]为0.32 - 0.97；P = 0.04），与Gleason评分为6或更低的男性相比也显著缩短（中位时间为15.4年；调整后HR为0.24；95% CI为0.13 - 0.43；P < 0.001）。然而，与Gleason评分为8至10的男性相比，未观察到显著差异（中位时间为5.1年；调整后HR为0.96；95% CI为0.54 - 1.71；P = 0.90）。
在本研究人群中，前列腺穿刺活检Gleason评分为7且三级分级为5的前列腺癌男性与Gleason评分为7但无三级分级5的男性相比，PSA失败风险更高，与Gleason评分为8至10的男性风险相当。
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