Institute of Pathology, University of Rostock, Strempelstraße 14, 18055, Rostock, Germany,
Virchows Arch. 2014 Apr;464(4):453-61. doi: 10.1007/s00428-014-1548-z. Epub 2014 Feb 18.
Since reliable molecular prognostic parameters for inguinal lymph metastases in penile cancer are not available, tumor grading is often used as a surrogate prognostic tool for the indication of inguinal lymphadenctomy and has been integrated into the current TNM classification for penile cancer. The reliability of tumor grading is under discussion. We examined interobserver grading variability in 90 primary penile carcinomas, assessed by 12 different uropathologists from five European countries. Tumor grading, following the CAP scheme, was compared, and interobserver variability was calculated using kappa statistics. The interobserver variability was high as reflected by an overall low kappa coefficient (mean k = 0.34) and reached a moderate level only in 26.4 % of the cases (range 0.02-0.67). The percentage of G1 tumors assigned ranged from 8.6 to 52.5 %, G2 tumors from 27.1 to 72.6 % and G3 tumors from 11.7 to 48.7 %. Only some observers assigned G4 with a range of 0.6-21.9 %. Subdivision into low and high grade according to UICC and EAU classifications differed significantly (P < 0.001). Low reproducibility of grading in penile carcinomas with the favored method does not allow a reliable prognostication of tumor aggressiveness. Inclusion of histological grading into the TNM classification currently seems not to be a benefit.
由于缺乏可靠的用于预测阴茎癌腹股沟淋巴结转移的分子预后参数，肿瘤分级常被用作腹股沟淋巴结清扫术适应证的替代预后工具，并已被纳入现行的阴茎癌 TNM 分期系统。肿瘤分级的可靠性存在争议。我们检查了 90 例原发性阴茎癌的 12 位来自 5 个欧洲国家的不同泌尿科医生的分级结果，采用 CAP 方案进行评估。比较肿瘤分级，计算 κ 统计量以评估观察者间的变异性。整体 κ 系数（平均κ=0.34）较低，表明观察者间的变异性较高，仅 26.4%的病例达到中度水平（范围 0.02-0.67）。G1 肿瘤的比例范围为 8.6%至 52.5%，G2 肿瘤为 27.1%至 72.6%，G3 肿瘤为 11.7%至 48.7%。仅有少数观察者（0.6%-21.9%）将 G4 肿瘤分配到该组。根据 UICC 和 EAU 分类进行的低级别和高级别分组差异具有统计学意义（P<0.001）。采用目前常用的方法对阴茎癌进行分级的重复性差，无法可靠预测肿瘤侵袭性。将组织学分级纳入 TNM 分期目前似乎没有益处。
