前列腺癌穿刺活检标本与根治手术标本Gleason评分差异的影响因素

Risk factors for Gleason score changes between biopsy pathology and radical prostatectomy specimen

Gleason评分系统是评估前列腺癌患者风险、选择治疗模式和判断预后的重要手段。越来越多的研究结果表明,穿刺标本和根治手术标本的Gleason评分一致率仅为39%~63%,Gleason评分在根治手术后升高者占30%~55%,降低者占7%~20%,这为临床决策带来困难。本文回顾国内外最新相关文献,从患者自身临床特征、穿刺技术相关因素、评分可靠性和病理报告解读等方面归纳分析,结果显示影响Gleason评分一致性的因素众多,基本与前列腺癌高危因素相符,但部分因素尚有争议。结合患者高危因素评估患者Gleason评分改变风险进而改变相应治疗模式,能够进一步精准地评估患者危险程度,为患者提供个体化的治疗方案。

Gleason grading system is a critical factor for assessing the risk,making treatment decision and evaluating prognosis for patients with prostate cancer.However,it has been reported that concordance rates of Gleason score between biopsy pathology and radical prostatectomy specimen were only39%-63%,whilst postsurgical upgrade and downgrade rates were 30%-55%and 7%-20%respectively.This situation brings difficulties in performing clinical practice.This literature aimed to review relevant and updated studies in literature to summarize the concordance rate and independent predictive factors of Gleason score change from following several aspects:patient clinical characteristics,biopsy-related factors,accuracy of pathologic assignment and interpretation of pathology reports.This review also investigated how the factors influenced the Gleason score change and clinical decision-making.There were many factors influencing the Gleason score change which were roughly consistent with risk factors of prostate cancer,however,some factors were controversial.In order to provide precise evaluation of risk stratification and optimal individualized treatment,it is essential to consider the risk factors which are correlated with Gleason score change.