Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA.
Eur Urol. 2012 May;61(5):1019-24. doi: 10.1016/j.eururo.2012.01.050. Epub 2012 Feb 8.
Prior studies assessing the correlation of Gleason score (GS) at needle biopsy and corresponding radical prostatectomy (RP) predated the use of the modified Gleason scoring system and did not factor in tertiary grade patterns.
To assess the relation of biopsy and RP grade in the largest study to date.
DESIGN, SETTING, AND PARTICIPANTS: A total of 7643 totally embedded RP and corresponding needle biopsies (2004-2010) were analyzed according to the updated Gleason system.
All patients underwent prostate biopsy prior to RP.
The relation of upgrading or downgrading to patient and cancer characteristics was compared using the chi-square test, Student t test, and multivariable logistic regression.
A total of 36.3% of cases were upgraded from a needle biopsy GS 5-6 to a higher grade at RP (11.2% with GS 6 plus tertiary). Half of the cases had matching GS 3+4=7 at biopsy and RP with an approximately equal number of cases downgraded and upgraded at RP. With biopsy GS 4+3=7, RP GS was almost equally 3+4=7 and 4+3=7. Biopsy GS 8 led to an almost equal distribution between RP GS 4+3=7, 8, and 9-10. A total of 58% of the cases had matching GS 9-10 at biopsy and RP. In multivariable analysis, increasing age (p<0.0001), increasing serum prostate-specific antigen level (p<0.0001), decreasing RP weight (p<0.0001), and increasing maximum percentage cancer/core (p<0.0001) predicted the upgrade from biopsy GS 5-6 to higher at RP. Despite factoring in multiple variables including the number of positive cores and the maximum percentage of cancer per core, the concordance indexes were not sufficiently high to justify the use of nomograms for predicting upgrading and downgrading for the individual patient.
Almost 20% of RP cases have tertiary patterns. A needle biopsy can sample a tertiary higher Gleason pattern in the RP, which is then not recorded in the standard GS reporting, resulting in an apparent overgrading on the needle biopsy.
先前评估前列腺针芯活检 Gleason 评分（GS）与根治性前列腺切除术（RP）相关性的研究应用的是改良 Gleason 评分系统，并未考虑到三级形态。
评估迄今为止最大规模的研究中活检和 RP 分级的关系。
设计、地点和参与者：根据最新的 Gleason 系统分析了总共 7643 例完全嵌入的 RP 和相应的针芯活检（2004-2010 年）。
所有患者在 RP 前均接受前列腺活检。
采用卡方检验、Student t 检验和多变量逻辑回归比较升级或降级与患者和癌症特征的关系。
共有 36.3%的病例从针芯活检 GS 5-6 升级到 RP 更高分级（11.2%为 GS 6 加三级）。一半的病例在活检和 RP 中匹配 GS 3+4=7，大约有一半的病例在 RP 中降级和升级。活检 GS 4+3=7 时，RP GS 几乎同样是 3+4=7 和 4+3=7。活检 GS 8 导致 RP GS 4+3=7、8 和 9-10 的分布几乎相等。共有 58%的病例在活检和 RP 中匹配 GS 9-10。多变量分析显示，年龄增加（p<0.0001）、血清前列腺特异性抗原水平升高（p<0.0001）、RP 重量减轻（p<0.0001）和最大癌症核心百分比增加（p<0.0001）预测了从活检 GS 5-6 升级到 RP 更高分级。尽管考虑了多个变量，包括阳性核心数和每个核心的最大癌症百分比，但一致性指数不足以高到足以证明使用列线图来预测个体患者的升级和降级。
几乎 20%的 RP 病例存在三级形态。RP 中可以采样到三级更高的 Gleason 形态，而在标准 GS 报告中未记录，导致针芯活检中出现明显的过分级。
