Mansouri Nada, Msakni Issam, Gargouri Faten, Khiari Ramzi, Bouziani Ammar, Laabidi Besma
Tunis Med. 2018 Jul;96(7):430-436.
Histological Gleason score grading is a main determinant of prostate cancer treatment. However, the final histological examination may reveal that concordance rates between biopsy and pathological Gleason sums are inadequate.
To evaluate the concordance of Gleason score between prostate biopsy and radical prostatectomy specimen and to study factors predictive of up-grading of Gleason score at radical prostatectomy.
We conducted a descriptive and retrospective study including cases of patients who underwent prostatectomy between 2008 and 2015. We proceeded to a histological examination of 30 cases of radical prostatectomy and 17 corresponding biopsies. The data of the remaining 13 prostate biopsies, not performed in our hospital, have been picked from detailed histological reports.
Our results showed that the concordance in the Gleason score was 43% (kappa = 0.11, poor agreement).Gleason score was upgraded in 54% of the cases. At radical prostatectomy, it increased by two points in one case and by one point in 14 cases. The Gleason score was under-graded on prostatic biopsies in an only 1 case. Using the new classification ISUP 2014, the concordance rate was 26% (kappa = 0.04, very poor agreement). Gleason score was upgraded in 78% of the cases for Group 1 (SG 3 + 3) and 63% for group 2 (SG 3 + 4). The concordance rate was highest for Group 4 (4 + 3). Variables as age, serum PSA (prostate specific antigen) , numbre of cores, percentage of positive cores, or prostate volume were not significant predictors of upgrading of Gleason score on radical prostatectomy specimen.
Thus, the high rate of discordance of Gleason score between prostate biopsy and radical prostatectomy specimen implies an understanding of factors predictive of discordance of this score allowing urologists, pathologists and oncologists to support patients in a more suitable way, choosing the appropriate therapeutic modality for each patient.
组织学Gleason评分分级是前列腺癌治疗的主要决定因素。然而，最终的组织学检查可能显示活检与病理Gleason总分之间的一致性率不足。
评估前列腺活检与根治性前列腺切除标本之间Gleason评分的一致性，并研究预测根治性前列腺切除时Gleason评分升级的因素。
我们进行了一项描述性回顾性研究，纳入2008年至2015年间接受前列腺切除术的患者病例。我们对30例根治性前列腺切除术病例和17例相应活检进行了组织学检查。其余13例未在我院进行的前列腺活检数据取自详细的组织学报告。
我们的结果显示，Gleason评分的一致性为43%（kappa = 0.11，一致性差）。54%的病例Gleason评分升级。在根治性前列腺切除术中，1例增加2分，14例增加1分。前列腺活检中Gleason评分仅1例降级。使用2014年国际泌尿病理学会（ISUP）新分类，一致性率为26%（kappa = 0.04，一致性非常差）。第1组（Gleason评分3 + 3）78%的病例和第2组（Gleason评分3 + 4）63%的病例Gleason评分升级。第4组（4 + 3）的一致性率最高。年龄、血清前列腺特异性抗原（PSA）、穿刺针数、阳性穿刺针百分比或前列腺体积等变量不是根治性前列腺切除标本中Gleason评分升级的显著预测因素。
因此，前列腺活检与根治性前列腺切除标本之间Gleason评分的高不一致率意味着需要了解该评分不一致的预测因素，以便泌尿外科医生、病理学家和肿瘤学家以更合适的方式为患者提供支持，为每位患者选择合适的治疗方式。
