在根治性前列腺切除术中，肿瘤边缘的 Gleason 评分可预测生化复发。
The Gleason score of tumor at the margin in radical prostatectomy is predictive of biochemical recurrence.
机构信息
Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO 63110, USA.
出版信息
Am J Surg Pathol. 2010 Jul;34(7):994-1001. doi: 10.1097/PAS.0b013e3181e103bf.
Gleason grading system is recommended by World Health Organization to grade prostate carcinoma. The Gleason score of the main tumor in prostate carcinoma is a powerful predictive factor for biochemical recurrence, but the significance of the Gleason score of tumor at the margin is unknown. In this study we aimed to investigate this subject in 336 patients (mean age 61 y, median 61, range 39 to 80; mean follow-up 41 mo, median 32, range 1 to 202) with a positive surgical margin in radical prostatectomy. The mean preoperative prostate specific antigen level was 8.2 ng/mL (median 5.8, range 0.9 to 85.0). The pathologic stage was T2, T3a, and T3b in 185, 127, and 24 patients, respectively. The Gleason score of the main tumor was 6, 7, 8, and 9 in 70 (all 3+3), 242 (3+4 in 186, 4+3 in 56), 8 (5+3 in 1, 4+4 in 7), and 16 (4+5 in 12, 5+4 in 4) patients, respectively. The Gleason score of the tumor at the margin was 6 in 220 (66%, all 3+3), 7 in 88 (26%, 3+4 in 59, 4+3 in 29), 8 in 19 (6%, all 4+4), 9 in 7 (2%, 4+5 in 4, 5+4 in 3), and 10 in 2 (1%) cases, respectively. The Gleason score concordance rate between the main tumor and the tumor at the margin was 69/70 (99%), 83/242 (34%), 5/8 (63%), and 6/16 (38%) in cases in which the main tumor had a Gleason score 6, 7, 8, and 9, respectively. The Gleason score of the tumor at the margin was lower, equal to, and higher than that of the main tumor in 160 (48%), 163 (49%), and 13 (4%) cases, respectively. The Gleason score of the tumor at the margin was strongly correlated with preoperative prostate-specific antigen, pathologic stage, the Gleason score of the main tumor, lymph node status, and the linear length of the tumor at the margin (P<0.05 for all). On both univariate and multivariate analysis, the Gleason score of the tumor at the margin was a strong predictive factor for biochemical recurrence (P<0.05). Among the patients with the same Gleason score in their main tumors (7 or above), those with a higher Gleason score of the tumor at the margin more likely had biochemical recurrence than those with a lower one. Reporting the Gleason score of the tumor at the margin can improve predictive accuracy of biochemical recurrence. We advocate reporting the Gleason score of tumor at the margin in radical prostatectomy.
格里森分级系统被世界卫生组织推荐用于前列腺癌分级。前列腺癌原发肿瘤的格里森评分是生化复发的有力预测因素，但肿瘤边缘的格里森评分的意义尚不清楚。在这项研究中，我们旨在调查 336 例根治性前列腺切除术后有阳性切缘的患者（平均年龄 61 岁，中位数 61 岁，范围 39-80 岁；平均随访 41 个月，中位数 32 个月，范围 1-202 个月）。术前前列腺特异性抗原水平平均为 8.2ng/ml（中位数 5.8ng/ml，范围 0.9-85.0ng/ml）。病理分期 T2、T3a 和 T3b 分别为 185、127 和 24 例。原发肿瘤的格里森评分为 6、7、8 和 9 的患者分别为 70 例（均为 3+3）、242 例（186 例为 3+4，56 例为 4+3）、8 例（1 例为 5+3，7 例为 4+4）和 16 例（12 例为 4+5，4 例为 5+4）。肿瘤边缘的格里森评分为 6 的患者为 220 例（66%，均为 3+3），7 的为 88 例（26%，59 例为 3+4，29 例为 4+3），8 的为 19 例（均为 4+4），9 的为 7 例（4+5 例，5+4 例），10 的为 2 例（均为 5+4）。原发肿瘤和肿瘤边缘的格里森评分一致率分别为 69/70（99%）、83/242（34%）、5/8（63%）和 6/16（38%），在格里森评分分别为 6、7、8 和 9 的病例中。肿瘤边缘的格里森评分低于、等于和高于原发肿瘤的患者分别为 160 例（48%）、163 例（49%）和 13 例（4%）。肿瘤边缘的格里森评分与术前前列腺特异性抗原、病理分期、原发肿瘤的格里森评分、淋巴结状态和肿瘤边缘的线性长度密切相关（P<0.05）。在单因素和多因素分析中，肿瘤边缘的格里森评分是生化复发的一个强有力的预测因素（P<0.05）。在原发肿瘤格里森评分相同（7 分或以上）的患者中，肿瘤边缘格里森评分较高的患者比肿瘤边缘格里森评分较低的患者更有可能发生生化复发。报告肿瘤边缘的格里森评分可以提高生化复发的预测准确性。我们主张在根治性前列腺切除术中报告肿瘤边缘的格里森评分。
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