Green G A, Hanlon A L, Al-Saleem T, Hanks G E
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA.
Cancer. 1998 Sep 1;83(5):971-6.
In most reported surgical series, prostate carcinoma patients with a Gleason score of 7 have had worse outcomes than those with other moderately differentiated cancers. Because of variations in reporting grade and grouping Gleason scores, radiation series have conflicting results.
Five hundred sixty-three men with clinical Stage T1-T3, N0 or Nx, M0 adenocarcinoma of the prostate and known pretreatment prostate specific (PSA) levels received external beam radiation only. The median pretreatment PSA was 10.3 ng/mL (range, 0.2-191 ng/mL). The median duration of follow-up was 42 months (range, 2-114 months). Survival without biochemical failure (bNED) was defined as PSA < or = 1.5 ng/mL and not rising when measured on two consecutive occasions.
The 5-year rate of bNED control for all 563 patients was 62%. Increasing Gleason score predicted for decreased bNED control (78% for 2-4, 63% for 5-6, 37% for 7, and 33% for 8-10 at 5 years; P = 0.0001 for overall comparison). The bNED control rate for patients with a Gleason score of 7 was significantly less than the rate for those with Gleason 5-6 in both univariate (P = 0.0008) and multivariate (P = 0.0068) analysis. T classification by palpation, pretreatment PSA, and dose were also shown to be independent predictors of bNED control in multivariate analysis.
Even after adjustment for other known prognostic factors, a Gleason score of 7 was associated with worse bNED control than Gleason scores of 2-4 and 5-6 among patients treated with external beam radiotherapy only for clinically localized prostate carcinoma. Patients with a Gleason score of 7 should not be lumped together with those who have a Gleason score of 5-6; they may instead benefit from more aggressive treatment strategies.
在大多数已报道的外科手术系列研究中， Gleason评分为7分的前列腺癌患者的预后比其他中度分化癌患者更差。由于在报告分级和对Gleason评分进行分组方面存在差异，放射治疗系列研究的结果相互矛盾。
563例临床分期为T1-T3、N0或Nx、M0的前列腺腺癌且已知治疗前前列腺特异性抗原（PSA）水平的男性仅接受了外照射放疗。治疗前PSA的中位数为10.3 ng/mL（范围为0.2-191 ng/mL）。随访的中位数时间为42个月（范围为2-114个月）。无生化失败生存（bNED）定义为PSA≤1.5 ng/mL且连续两次测量时未升高。
所有563例患者的5年bNED控制率为62%。Gleason评分增加预示着bNED控制率降低（5年时，Gleason 2-4分为78%，5-6分为63%，7分为37%，8-10分为33%；总体比较P = 0.0001）。在单因素分析（P = 0.0008）和多因素分析（P = 0.0068）中，Gleason评分为7分的患者的bNED控制率均显著低于Gleason 5-6分的患者。在多因素分析中，通过触诊进行的T分期、治疗前PSA和剂量也被证明是bNED控制的独立预测因素。
即使在对其他已知预后因素进行调整后，在仅接受外照射放疗治疗临床局限性前列腺癌的患者中，Gleason评分为7分与bNED控制情况比Gleason 2-4分和5-6分更差相关。Gleason评分为7分的患者不应与Gleason评分为5-6分的患者归为一类；他们可能反而会从更积极的治疗策略中获益。
