Hassan Oudai, Matoso Andres
Department of Pathology, University of Oklahoma, Oklahoma City, OK, USA.
Departments of Pathology and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Transl Androl Urol. 2018 Sep;7(Suppl 4):S477-S483. doi: 10.21037/tau.2018.02.06.
Major updates in prostate cancer grading have been adopted in recent times. These include redefinitions of Gleason pattern (GP) 4 architectural variants and reporting of the grade group (GG) system, which divides prostate cancer into five groups that better stratify patients. Still, the GG system uses the GPs 3, 4 or 5 to define each GG. Patients belonging to GG 2, 3 and 4 have increasing amounts of GP 4 in the composition of their tumors. GP4 is a heterogeneous group of morphologic variants that include poorly formed glands, glomeruloid structures, cribriform glands, and fused glands. Recently published studies suggest that the morphologic subtypes of GP 4 have different clinical significance. While the diagnostic reproducibility of poorly formed glands and fused glands is low, glomeruloid structures and cribriform glands are easier to be distinguished from other morphologies. A growing body of evidence suggests that the presence of cribriform glands is associated with an aggressive clinical course compared with other architectural subtypes. The latest 2014 guidelines issued by the International Society of Urologic Pathology recommend that the percentage of GP 4 be reported on needle biopsies and radical prostatectomy (RP) specimens. The data reviewed here invites consideration for the need to report the subtype of GP 4, especially the presence or absence of cribriform glands.
近年来，前列腺癌分级有了重大更新。这些更新包括对 Gleason 模式（GP）4 结构变异的重新定义以及分级组（GG）系统的报告，该系统将前列腺癌分为五组，能更好地对患者进行分层。尽管如此，GG 系统仍使用 GP 3、4 或 5 来定义每个 GG。属于 GG 2、3 和 4 的患者肿瘤成分中 GP 4 的含量逐渐增加。GP4 是一组形态学变异的异质性群体，包括形态不佳的腺体、肾小球样结构、筛状腺体和融合腺体。最近发表的研究表明，GP 4 的形态学亚型具有不同的临床意义。虽然形态不佳的腺体和融合腺体的诊断可重复性较低，但肾小球样结构和筛状腺体更容易与其他形态区分开来。越来越多的证据表明，与其他结构亚型相比，筛状腺体的存在与侵袭性临床病程相关。国际泌尿病理学会发布的最新 2014 年指南建议，在穿刺活检和根治性前列腺切除术（RP）标本中报告 GP 4 的百分比。此处回顾的数据促使人们考虑报告 GP 4 亚型的必要性，尤其是筛状腺体的有无。
