Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
Histopathology. 2012 Jan;60(1):75-86. doi: 10.1111/j.1365-2559.2011.04003.x.
In 1966 Donald Gleason developed his grading and scoring system for prostatic adenocarcinoma. This classification was refined in 1974 and gained almost universal acceptance, being classified as a category 1 prognostic parameter by the College of American Pathologists. Modifications to the classification were recommended at a conference convened by the International Society of Urological Pathology (ISUP) in 2005. This modified classification has resulted in a significant upgrading of tumours, although some studies have shown a greater concordance between needle biopsy and radical prostatectomy scores when compared to classical Gleason (CG) grading. The ISUP consensus conference recommended that for needle biopsies higher tertiary patterns should be incorporated into the final Gleason score, and this has been correlated with biochemical failure, tumour volume and mortality. Recently the validity of including cribriform glands as a component of Gleason pattern 3 has been questioned and it has been recommended that all tumours showing cribriform architecture should be classified as Gleason pattern 4. The recommendations arising from the 2005 Consensus Conference were largely unsupported by validating data, yet this new grading system has achieved widespread usage. It is unfortunate that recent suggestions for further modification are similarly lacking in supporting evidence. In view of this it is recommended that the Modified Gleason Scoring Classification should continue to be utilized in its original (2005) format and that any future alterations should be implemented only when mandated by tumour-related outcome studies.
1966 年，Donald Gleason 提出了前列腺腺癌的分级和评分系统。该分类法于 1974 年得到进一步完善，并几乎得到了普遍认可，被美国病理学家学院（College of American Pathologists）归类为 1 类预后参数。2005 年，国际泌尿病理学会（International Society of Urological Pathology，ISUP）召开了一次会议，对该分类法进行了修订。该修订分类显著提高了肿瘤的分级，但一些研究表明，与经典 Gleason（CG）分级相比，针芯活检和根治性前列腺切除术的评分之间的一致性更高。ISUP 共识会议建议，对于针芯活检，应将更高的三级模式纳入最终的 Gleason 评分中，这与生化失败、肿瘤体积和死亡率相关。最近，关于将筛状腺体纳入 Gleason 模式 3 的成分的有效性提出了质疑，并建议将所有显示筛状结构的肿瘤归类为 Gleason 模式 4。2005 年共识会议提出的建议在很大程度上没有得到验证数据的支持，但这种新的分级系统已经得到了广泛的应用。不幸的是，最近提出的进一步修改建议同样缺乏支持证据。鉴于此，建议继续按照原始（2005 年）格式使用改良 Gleason 评分分类法，并且只有在肿瘤相关结局研究要求时，才应实施任何未来的更改。
