Berney Daniel M, Fisher Gabrielle, Kattan Michael W, Oliver R Timothy D, Møller Henrik, Fearn Paul, Eastham James, Scardino Peter, Cuzick Jack, Reuter Victor E, Foster Christopher S
Department of Histopathology, St Bartholomew's Hospital, Queen Mary University of London, London, UK.
BJU Int. 2007 Dec;100(6):1240-4. doi: 10.1111/j.1464-410X.2007.07199.x.
To examine data on the changes in the accuracy of the diagnosis of prostate cancer and of Gleason grading in the modern era.
The study comprised a pathological review within a multicentre study of patients with clinically localized prostate cancer diagnosed in the UK from 1991 to 1996 (inclusive) and treated by watchful-waiting or hormonal therapy alone. The clinical follow-up was available, histopathological appearances were reviewed and the Gleason score at diagnosis was compared with the Gleason score as analysed by a panel of genitourinary pathologists using internationally agreed criteria. In all, 1789 patients diagnosed with prostate cancer between 1991 and 1996 were reviewed, with disease-specific survival as the main outcome measure.
In all, 133 patients (7%) were reassigned a nonmalignant diagnosis. There was a significant reassignment in the Gleason score for those with cancer, with increases of Gleason score across a wide spectrum. In multivariate analysis the revised Gleason score was a more accurate predictor of prognosis than the original score.
Misdiagnosis and reassignment of Gleason score at diagnosis would have guided clinicians into large-scale changes in the management of patients. Current rates of misdiagnosis are unknown. If applicable nationally, these changes would have profound effects on the workload of prostate cancer management in the UK.
研究现代前列腺癌诊断准确性及Gleason分级的变化数据。
本研究是一项多中心研究的病理回顾，研究对象为1991年至1996年（含）在英国诊断为临床局限性前列腺癌且仅接受观察等待或激素治疗的患者。有临床随访资料，回顾组织病理学表现，并将诊断时的Gleason评分与一组泌尿生殖病理学家按照国际公认标准分析得出的Gleason评分进行比较。总共对1991年至1996年间诊断为前列腺癌的1789例患者进行了回顾，以疾病特异性生存作为主要结局指标。
共有133例患者（7%）被重新诊断为非恶性疾病。癌症患者的Gleason评分有显著重新分类，Gleason评分在很大范围内升高。多因素分析显示，修订后的Gleason评分比原始评分更能准确预测预后。
诊断时的误诊和Gleason评分重新分类会引导临床医生对患者管理进行大规模改变。目前的误诊率尚不清楚。如果在全国范围内适用，这些变化将对英国前列腺癌管理的工作量产生深远影响。
