Clinical Utility of Quantitative Gleason Grading in Prostate Biopsies and Prostatectomy Specimens

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• 作者：Guido Sauter^a ; ^{g.sauter@uke.de" class="auth_mail" title="E-mail the corresponding author} ; Stefan Steurer^a ; Till Sebastian Clauditz^a ; Till Krech^a ; Corinna Wittmer^a ; Florian Lutz^a ; Maximilian Lennartz^a ; Tim Janssen^a ; Nayira Hakimi^a ; Ronald Simon^a ; Mareike von Petersdorff-Campen^a ; Frank Jacobsen^a ; Katharina von Loga^a ; Waldemar Wilczak^a ; Sarah Minner^a ; Maria Christina Tsourlakis^a ; Viktoria Chirico^a ; Alexander Haese^b ; Hans Heinzer^b ; Burkhard Beyer^b ; Markus Graefen^b ; Uwe Michl^b ; Georg Salomon^b ; Thomas Steuber^b ; Lars Henrik Bud&auml ; us^b ; Elena Hekeler^a ; Julia Malsy-Mink^a ; Sven Kutzera^a ; Christoph Fraune^a ; Cosima Gö ; bel^a ; Hartwig Huland^b ; Thorsten Schlomm^b ; ^c
• 关键词：Prostate cancer ; Gleason score ; Quantitative Gleason grade ; Prognosis
• 刊名：European Urology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：69
• 期：4
• 页码：592-598
• 全文大小：1182 K

文摘

Gleason grading is the strongest prognostic parameter in prostate cancer. Gleason grading is categorized as Gleason ≤6, 3 + 4, 4 + 3, 8, and 9–10, but there is variability within these subgroups. For example, Gleason 4 components may range from 5–45% in a Gleason 3 + 4 = 7 cancer.

Objective

spar0010">To assess the clinical relevance of the fractions of Gleason patterns.

Design, setting, and participants

spar0015">Prostatectomy specimens from 12 823 consecutive patients and of 2971 matched preoperative biopsies for which clinical data with an annual follow-up between 2005 and 2014 were available from the Martini-Klinik database.

Outcome measurements and statistical analysis

spar0020">To evaluate the utility of quantitative grading, the fraction of Gleason 3, 4, and 5 patterns seen in biopsies and prostatectomies were recorded. Gleason grade fractions were compared with prostatectomy findings and prostate-specific antigen recurrence.

Results and limitations

spar0025">Our data suggest a striking utility of quantitative Gleason grading. In prostatectomy specimens, there was a continuous increase of the risk of prostate-specific antigen recurrence with increasing percentage of Gleason 4 fractions with remarkably small differences in outcome at clinically important thresholds (0% vs 5%; 40% vs 60% Gleason 4), distinguishing traditionally established prognostic groups. Also, in biopsies, the quantitative Gleason scoring identified various intermediate risk groups with respect to Gleason findings in corresponding prostatectomies. Quantitative grading may also reduce the clinical impact of interobserver variability because borderline findings such as tumors with 5%, 40%, or 60% Gleason 4 fractions and very small Gleason 5 fractions (with pivotal impact on the Gleason score) are disclaimed.

Conclusions

spar0030">Quantitative Gleason pattern data should routinely be provided in addition to Gleason score categories, both in biopsies and in prostatectomy specimens.

Patient summary

spar0035">Gleason score is the most important prognostic parameter in prostate cancer, but prone to interobserver variation. The results of our study show that morphological aspects that define the Gleason grade in prostate cancer represent a continuum. Quantitation of Gleason patterns provides clinically relevant information beyond the traditional Gleason grading categories ≤3 + 3, 3 + 4, 4 + 3, 8, 9–10. Quantitative Gleason scoring can help to minimize variations between different pathologists and substantially aid in optimized therapy decision-making.