Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Eur Urol. 2018 May;73(5):674-683. doi: 10.1016/j.eururo.2017.01.015. Epub 2017 Jan 20.
Presence of small (tertiary) Gleason 5 pattern is linked to a higher risk of biochemical recurrence in prostate cancer. It is unclear, however, how to integrate small Gleason 5 elements into clinically relevant Gleason grade groups.
To analyze the prognostic impact of Gleason 5 patterns in prostate cancer and to develop a method for integrating tertiary Gleason 5 patterns into a quantitative Gleason grading system.
DESIGN, SETTING, AND PARTICIPANTS: Prostatectomy specimens from 13 261 consecutive patients and of 3295 matched preoperative biopsies were available. Percentages of Gleason 3, 4, and 5 had been recorded for each cancer. Outcome measurements and statistical analysis: RESULTS AND LIMITATIONS: Our data demonstrate that minimal Gleason 5 areas have strong prognostic impact in Gleason 7 carcinomas, while further expansion of the Gleason 5 pattern population has less impact. We thus defined an integrated quantitative Gleason score (IQ-Gleason) by adding a lump score of 10 to the percentage of unfavorable Gleason pattern (Gleason 4/5) if any Gleason 5 was present and by adding another 7.5 points in case of a Gleason 5 fraction >20%. There was a continuous increase of the risk of prostate-specific antigen recurrence with increasing IQ-Gleason. This was also true for subgroups with identical Cancer of the Prostate Risk Assessment Postsurgical scores (p<0.0001) or Gleason grade groups (p<0.0001).
The IQ-Gleason represents a simple and efficient approach for combining both quantitative Gleason grading and tertiary Gleason grades in one highly prognostic numerical variable.
Prostatectomy specimens (13 261) were analyzed to estimate the relevance of small Gleason 5 elements in prostate cancers. Even the smallest Gleason 5 areas markedly increased the risk of prostate-specific antigen recurrence after surgery. Larger fractions of Gleason 5 patterns had less further impact on prognosis. Based on this, a numerical Gleason score (integrated quantitative Gleason score) was defined by the percentages of Gleason 4 and 5 patterns, enabling a refined estimate of patient prognosis.
存在小（三级）Gleason 5 模式与前列腺癌生化复发的风险增加有关。然而，如何将小的 Gleason 5 成分整合到临床相关的 Gleason 分级组中尚不清楚。
分析前列腺癌中 Gleason 5 模式的预后影响，并开发一种将三级 Gleason 5 模式纳入定量 Gleason 分级系统的方法。
设计、设置和参与者：13261 例连续前列腺切除术标本和 3295 例匹配的术前活检标本可供使用。记录了每个肿瘤的 Gleason 3、4 和 5 的百分比。
结果和局限性：我们的数据表明，最小的 Gleason 5 区域在 Gleason 7 癌中有很强的预后影响，而进一步扩大 Gleason 5 模式人群的影响较小。因此，我们通过在存在任何 Gleason 5 的情况下将 10 分的肿块评分添加到不利的 Gleason 模式（Gleason 4/5）的百分比中，并在 Gleason 5 分数>20%的情况下再添加 7.5 分，定义了一个综合的定量 Gleason 评分（IQ-Gleason）。随着 IQ-Gleason 的增加，前列腺特异性抗原复发的风险持续增加。在相同的前列腺癌风险评估术后评分（p<0.0001）或 Gleason 分级组（p<0.0001）的亚组中也是如此。
IQ-Gleason 代表了一种简单有效的方法，可将定量 Gleason 分级和三级 Gleason 分级结合到一个高度预测性的数值变量中。
分析了前列腺切除术标本（13261 例）以评估前列腺癌中小 Gleason 5 成分的相关性。即使是最小的 Gleason 5 区域也会显著增加手术后前列腺特异性抗原复发的风险。更大比例的 Gleason 5 模式对预后的影响较小。基于此，通过 Gleason 4 和 5 模式的百分比定义了一个数值 Gleason 评分（综合定量 Gleason 评分），能够更准确地估计患者的预后。
