Gordetsky Jennifer, Epstein Jonathan
Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.
Diagn Pathol. 2016 Mar 9;11:25. doi: 10.1186/s13000-016-0478-2.
Despite significant changes in the clinical and histologic diagnosis of prostate cancer, the Gleason grading system remains one of the most powerful prognostic predictors in prostate cancer. The correct diagnosis and grading of prostate cancer is crucial for a patient's prognosis and therapeutic options. However, this system has undergone significant revisions and continues to have deficiencies that can potentially impact patient care.
We describe the current state of grading prostate cancer, focusing on the current guidelines for the Gleason grading system and recent changes from the 2014 International Society of Urological Pathology Consensus Conference on Gleason Grading of Prostatic Carcinoma. We also explore the limitations of the current Gleason grading system and present a validated alternative to the Gleason score. The new grading system initially described in 2013 in a study from Johns Hopkins Hospital and then validated in a multi-institutional study, includes five distinct Grade Groups based on the modified Gleason score groups. Grade Group 1 = Gleason score ≤6, Grade Group 2 = Gleason score 3 + 4 = 7, Grade Group 3 = Gleason score 4 + 3 = 7, Grade Group 4 = Gleason score 8, Grade Group 5 = Gleason scores 9 and 10.
As this new grading system is simpler and more accurately reflects prostate cancer biology, it is recommended by the World Health Organization (WHO) to be used in conjunction with Gleason grading.
尽管前列腺癌的临床和组织学诊断发生了重大变化，但 Gleason 分级系统仍然是前列腺癌最有力的预后预测指标之一。前列腺癌的正确诊断和分级对于患者的预后和治疗选择至关重要。然而，该系统已经历了重大修订，并且仍然存在可能影响患者护理的缺陷。
我们描述了前列腺癌分级的现状，重点关注 Gleason 分级系统的当前指南以及 2014 年国际泌尿病理学会前列腺癌 Gleason 分级共识会议的最新变化。我们还探讨了当前 Gleason 分级系统的局限性，并提出了一种经过验证的 Gleason 评分替代方法。新的分级系统最初于 2013 年在约翰霍普金斯医院的一项研究中进行了描述，随后在一项多机构研究中得到验证，它基于改良的 Gleason 评分组包括五个不同的分级组。分级组 1 = Gleason 评分≤6，分级组 2 = Gleason 评分 3 + 4 = 7，分级组 3 = Gleason 评分 4 + 3 = 7，分级组 4 = Gleason 评分 8，分级组 5 = Gleason 评分 9 和 10。
由于这种新的分级系统更简单且更准确地反映了前列腺癌生物学特性，世界卫生组织（WHO）建议将其与 Gleason 分级结合使用。
