穿刺活检前列腺癌119例病理形态、Gleason分级及预后分组

Pathological features,Gleason grading and prognostic grade grouping of prostatic carcinoma:analyses of 119 cases of prostate needle biopsy specimens

目的依据2014年国际泌尿病理协会(ISUP)修订的前列腺癌Gleason分级系统和以预后区别为基础的新的前列腺癌分级分组系统观察前列腺癌Gleason各分级的组织形态特征及了解预后分组情况。方法收集119例前列腺穿刺活检确诊为前列腺癌的标本,回顾性复习HE组织切片,观察病理学特点并依据2014年ISUP修订的前列腺癌Gleason分级系统和以预后区别为基础的新的前列腺癌分级分组系统进行分级和分组。结果 119例前列腺癌中以Gleason 3级为主要或次要结构的73例(61.3%),以Gleason 4级为主要或次要结构的104例(87.4%),以Gleason 5级为主要或次要(最高)结构的21例(17.6%)。前列腺癌预后分组结果是1级组12例(10.1%),2级组23例(19.3%),3级组37例(31.1%),4级组27例(22.7%),5级组20例(16.8%)。结论前列腺癌以Gleason 4级结构最多见且常与3级结构混合存在;Gleason 4级和5级的正确病理诊断对预后分组及选择治疗方式意义重大。更简化的基于Gleason评分的新的分级分组系统可作为Gleason分级系统的补充与其联合应用,将有助于对前列腺癌进行更精确规范的分级,准确反映肿瘤预后的差异。

Objective To observe pathological changes in prostatic carcinoma needle biopsy samples and grading based on the International Society of Urological Pathology（ISUP） modified Gleason grading system（2014） and a new prognostic grouping system. Methods 119 needle biopsy specimens of diagnosed prostatic cancer were collected. Information with respect to Gleason patterns,Gleason scores and a new 5-tier ISUP grading were made based on the refinements of the ISUP 2014 consensus conference on grading of prostate carcinoma. Results In the 119 needle core cases examined,73（61. 3%） cases had adenocarcinoma of Gleason 3 as the primary or secondary patterns,104（87. 4%） cases had adenocarcinoma of Gleason 4 as the primary or secondary patterns,and 21（17. 6%） cases had adenocarcinoma of Gleason5 as the primary or secondary（worst） patterns. The new prognostic grade grouping system results showed twelve（10. 1%）patients were classified as Grade Group 1,twenty-three（19. 3%） Grade Group 2,thirty-seven（31. 1%） Grade Group 3,twenty-seven（22. 7%） Grade Group 4,and twenty（16. 8%） Grade Group 5. Conclusion Gleason 4 is the most common pattern and often mixed with Gleason 3. Because of the important prognostic and therapeutic implications,pathologists must be aware of its importance of accurate recognition of Gleason patterns 4 and 5 on core biopsy. The new Grade Group classification of prostate cancer provides a simple system that addresses at least some of the deficiencies of the modified Gleason grading system and leads to improved prognostic value,and therefore it has been recommended using in conjunction with Gleason grading system.