Baylor Scott and White Health, Dallas, TX.
Olin E. Teague Veterans' Medical Center, Temple, TX.
Am J Clin Pathol. 2021 Apr 26;155(5):711-717. doi: 10.1093/ajcp/aqaa130.
We evaluated how the changes in Gleason grading affected the long-term outcomes of a large prostatectomy cohort.
We obtained long-term follow-up (16.7 years) in 581 patients having undergone radical retropubic prostatectomy between 1985 and 1995. We excluded those with seminal vesicle and/or lymphatic involvement. We regraded the specimens according to contemporary guidelines and compared how this affected outcomes compared with their original (pre-1995) Gleason scoring. In total, 499 patients were evaluable.
A Gleason score of 6 or less declined from 73% to 29%, and the number increased from 25% to 63% for a Gleason score of 7 and from 5% to 8% for a Gleason score of 8 to 9. As a result, for a Gleason score less than 7, biochemical failure decreased from 28% to 23%, metastatic disease 5% to 2%, and prostate cancer death from 5% to 3%. The same results were 50% to 37%, 11% to 7%, and 10% to 6% for a Gleason score of 7 and 86% to 71%, 43% to 32%, and 29% to 26% for a Gleason score more than 7, respectively. With the most recent grade grouping, for groups 1 to 5, biochemical failure occurred in 23%, 32%, 45%, 69%, and 78%, respectively. Metastatic disease occurred in 2%, 4%, 12%, 24%, and 56%, respectively. Prostate cancer-related death occurred in 2%, 4%, 9%, 21%, and 44%, respectively.
The revised Gleason scores improved the outcomes in all risk groups. Based on Gleason score, patients with prostate cancer will appear to have better outcomes than they did before 2005, making any comparison tenable. The current grading system shows a consistent increased risk in biochemical failure, metastatic disease, and prostate cancer-related death with each successive grade.
我们评估了格里森分级变化如何影响大型前列腺切除术队列的长期结果。
我们获得了 581 例 1985 年至 1995 年接受根治性耻骨后前列腺切除术患者的长期随访（16.7 年）。我们排除了那些有精囊和/或淋巴受累的患者。我们根据当代指南重新分级标本，并比较了这与他们最初（1995 年前）的格里森评分相比如何影响结果。共有 499 例患者可评估。
格里森评分 6 或更低的患者从 73%下降到 29%，评分 7 的患者从 25%增加到 63%，评分 8 至 9 的患者从 5%增加到 8%。结果，对于格里森评分低于 7 的患者，生化失败从 28%下降到 23%，转移疾病从 5%下降到 2%，前列腺癌死亡从 5%下降到 3%。对于格里森评分 7 和 8 的患者，结果分别为 50%至 37%、11%至 7%和 10%至 6%，对于格里森评分大于 7 的患者，结果分别为 86%至 71%、43%至 32%和 29%至 26%。根据最新的分级分组，对于第 1 至 5 组，生化失败发生率分别为 23%、32%、45%、69%和 78%。转移疾病发生率分别为 2%、4%、12%、24%和 56%。前列腺癌相关死亡率分别为 2%、4%、9%、21%和 44%。
修订后的格里森评分改善了所有风险组的结果。根据格里森评分，前列腺癌患者的预后似乎比 2005 年前更好，因此任何比较都是可行的。当前的分级系统显示，生化失败、转移疾病和前列腺癌相关死亡的风险随着每一级的增加而持续增加。
