Department of Pathology, Johns Hopkins Hospital, Weinberg Building, 401 North Broadway, Baltimore, MD 21231, USA.
Nat Rev Urol. 2010 Mar;7(3):136-42. doi: 10.1038/nrurol.2010.9. Epub 2010 Feb 16.
Remarkably, more than 40 years after the inception of the Gleason grading system, it remains one of the most powerful prognostic predictors in prostate cancer. Gleason's original grading system, however, has undergone significant revision over the years, first by Gleason and his colleagues, and most recently at the 2005 International Society of Urological Pathology Consensus Conference. The consensus conference and subsequent articles proposing further modifications have helped pathologists to adapt the Gleason grading system to current urologic practice in a uniform manner. The changing definitions of Gleason pattern 3 and 4 prostatic adenocarcinoma have tended to narrow the scope of pattern 3 carcinoma and widen the scope of pattern 4 carcinoma. These modifications have had an important role in improving the inter-observer reproducibility of the Gleason system. Whether these changes have a significant impact on the clinical treatment of prostate cancer remains to be seen. However, as many of these modifications are supported only by a few studies, long-term follow-up studies with clinical end points are essential to validate these recommendations.
值得注意的是，在格里森分级系统提出 40 多年后，它仍然是前列腺癌中最强大的预后预测因子之一。然而，格里森最初的分级系统多年来经历了重大修订，首先是由格里森及其同事进行的修订，最近在 2005 年国际泌尿病理学会共识会议上进行了修订。共识会议和随后提出进一步修改的文章帮助病理学家以统一的方式使格里森分级系统适应当前的泌尿科实践。格里森 3 型和 4 型前列腺腺癌模式定义的变化往往使 3 型癌的范围变窄，使 4 型癌的范围变宽。这些修改对提高格里森系统的观察者间可重复性起到了重要作用。这些变化是否对前列腺癌的临床治疗有重大影响还有待观察。然而，由于这些变化大多仅得到少数研究的支持，因此需要进行具有临床终点的长期随访研究来验证这些建议。
