Whittemore Darren E, Hick Eric J, Carter Mark R, Moul Judd W, Miranda-Sousa Alejandro J, Sexton Wade J
Department of Pathology, Mike O'Callaghan Federal Hospital, Nellis Air Force Base, Nevada, USA.
J Urol. 2008 Feb;179(2):516-22; discussion 522. doi: 10.1016/j.juro.2007.09.085.
The Gleason grading system in reporting prostate cancer accounts for the primary and secondary Gleason pattern. The clinical significance of a higher tertiary (third most prevalent) grade is largely unrecognized.
Radical prostatectomy specimens from 300 patients with Gleason score 7 (3 + 4 or 4 + 3) prostate cancer were pathologically reexamined for the presence of a tertiary grade 5 pattern as well as the association with pathological stage and biochemical recurrence-free survival.
A total of 214 patients met study inclusion criteria. Patients with Gleason score 7 and tertiary grade 5 cancer had significantly higher pathological stage disease than patients with Gleason score 7 without tertiary grade 5 cancer (p <0.001). Gleason score 7 + tertiary pattern 5 tumors were significantly associated with adverse pathological features such as seminal vesicle invasion, extraprostatic extension and lymphovascular invasion compared to Gleason score 7 tumors (p <0.05). The relative effects of a tertiary grade 5 component on all pathological parameters analyzed was greater for Gleason score 7 tumors with a lower primary Gleason pattern 3 vs a higher primary Gleason pattern 4. Patients with Gleason score 7 + tertiary pattern 5 tumors had significantly decreased biochemical recurrence-free survival (54 months) compared to patients with Gleason score 7 tumors (121 months) (p = 0.0005). Preoperative prostate specific antigen, lymphovascular invasion and positive surgical margin status were shown to be independent predictors of prostate specific antigen recurrence on multivariate analysis.
Small percentages of tertiary grade 5 patterns in Gleason score 7 radical prostatectomy specimens are associated with aggressive pathological features predictive of advanced pathological stage and biochemical recurrence-free survival.
在前列腺癌报告中，Gleason分级系统考虑了主要和次要的Gleason模式。较高的三级（第三常见）分级的临床意义在很大程度上未被认识到。
对300例Gleason评分为7（3 + 4或4 + 3）的前列腺癌患者的根治性前列腺切除术标本进行病理复查，以确定是否存在三级5级模式以及与病理分期和无生化复发生存期的关联。
共有214例患者符合研究纳入标准。Gleason评分为7且伴有三级5级癌的患者，其病理分期疾病明显高于无三级5级癌的Gleason评分为7的患者（p <0.001）。与Gleason评分为7的肿瘤相比，Gleason评分为7 +三级模式5的肿瘤与精囊侵犯、前列腺外扩展和淋巴管侵犯等不良病理特征显著相关（p <0.05）。对于主要Gleason模式为3较低的Gleason评分为7的肿瘤，与主要Gleason模式为4较高的肿瘤相比，三级5级成分对所有分析的病理参数的相对影响更大。与Gleason评分为7的肿瘤（121个月）相比，Gleason评分为7 +三级模式5的肿瘤患者的无生化复发生存期显著缩短（54个月）（p = 0.0005）。多因素分析显示，术前前列腺特异性抗原、淋巴管侵犯和手术切缘阳性状态是前列腺特异性抗原复发的独立预测因素。
Gleason评分为7的根治性前列腺切除术标本中，少量的三级5级模式与侵袭性病理特征相关，这些特征可预测晚期病理分期和无生化复发生存期。
