Department of Surgical Pathology, Gregorio Marañon General Hospital, Madrid, Spain.
Urol Oncol. 2012 Jul-Aug;30(4):386-90. doi: 10.1016/j.urolonc.2010.05.007. Epub 2011 Feb 2.
Gleason grading of prostatic specimens remains as one of the most powerful factors predicting prognosis in patients with prostate cancer. This grading system was created by Donald Gleason about 49 years ago and it takes into account the 2 most prevalent grades in the tumor sample, but it does not consider the presence of a third high grade pattern when it represents less than 5% of the whole radical prostatectomy specimen.
The objective of the present study is to determine whether the existence of a third pattern of growth in the radical prostatectomy samples correlates with a shorter recurrence free survival.
We have reviewed 85 consecutive specimens of radical prostatectomy from patients with clinical localized disease. Those who received previous hormonal or radiation therapy were excluded. We have determined the Gleason grade and also the presence of a third higher grade pattern, surgical margins status, capsular, vascular, and lymphatic invasion. We have analyzed whether the existence of this high grade third pattern areas influences prognosis. Recurrence was defined with PSA levels (biochemical recurrence).
We have shown that the presence of a Gleason's grade 5 pattern of growth worsens prognosis in patients with tumors grade 7 (both 3 + 4 and 4 + 3), with a shorter time to recurrence. The latter group of patients behaves more like patients with Gleason 8 tumors. This worse prognosis should be taken into account for patient surveillance and future adjuvant therapies. We feel this information is relevant and should be reported in the pathology reports.
前列腺标本的 Gleason 分级仍然是预测前列腺癌患者预后的最有力因素之一。该分级系统由 Donald Gleason 大约 49 年前创建，它考虑了肿瘤样本中最常见的 2 种等级，但当第三个高等级模式代表整个前列腺根治性切除术标本的 5%以下时，它不考虑其存在。
本研究的目的是确定前列腺根治性切除标本中是否存在第三种生长模式与无复发生存时间较短之间是否存在相关性。
我们回顾了 85 例连续的局部临床疾病前列腺根治性切除术标本。排除了接受过激素或放疗的患者。我们确定了 Gleason 分级，以及是否存在第三种高级别模式、手术切缘状态、包膜、血管和淋巴侵犯。我们分析了这种高级别第三模式区域的存在是否影响预后。复发定义为 PSA 水平（生化复发）。
我们表明，在肿瘤分级为 7 级（3+4 和 4+3）的患者中，存在 Gleason 5 级生长模式会使预后恶化，复发时间更短。后一组患者的表现更类似于 Gleason 8 级肿瘤的患者。这种较差的预后应在患者的监测和未来的辅助治疗中考虑到。我们认为这些信息是相关的，应该在病理报告中报告。
