We compared the predictive ability of the 2014 and 2005 Gleason grading systems in 568 patients initially diagnosed with metastatic prostate cancer （PCa）. Outcomes included the duration of castration-resistant prost...We compared the predictive ability of the 2014 and 2005 Gleason grading systems in 568 patients initially diagnosed with metastatic prostate cancer （PCa）. Outcomes included the duration of castration-resistant prostate cancer-free survival （CFS） and overall survival （OS）. Univariate analyses and log-rank tests were used to identify prognosis indicators and assess univariable differences in CFS and OS in Gleason score （GS） groups. Cox proportional hazards and area under the curves of receiver operator characteristics methods were used to evaluate the predictive efficacy of the 2005 and 2014 ISUP grading systems. Univariate analyses showed that the 2005 and 2014 grading systems were prognosticators for CFS and OS; both systems could distinguish the clinical outcome of patients with GS 6, GS 7, and GS 8-10. Using the 2014 criteria, no statistical differences in patient survival were observed between GS 3 ＋ 4 and GS 4 ＋ 3 or GS 8 and GS 9-10. The predictive ability of the 2014 and 2005 grading systems was comparable for CFS and OS （P = 0.321）. However, the 2014 grading system did not exhibit superior predictive efficacy in patients initially diagnosed with PCa and bone metastasis; trials using larger cohorts are required to confirm its predictive value. To the best of our knowledge, ours is the first study to compare the 2005 and 2014 grading systems in initially diagnosed PCa with bone metastasis. At present, we recommend that both systems should be used to predict the prognosis of patients with metastatic PCa.展开更多
The Gleason grading system for prostate adenocarcinoma has evolved from its original scheme established in the 1960s-1970s, to a significantly modified system after two major consensus meetings conducted by the Intern...The Gleason grading system for prostate adenocarcinoma has evolved from its original scheme established in the 1960s-1970s, to a significantly modified system after two major consensus meetings conducted by the International Society of Urologic Pathology （ISUP） in 2005 and 2014, respectively. The Gleason grading system has been incorporated into the WHO classification of prostate cancer, the AJCC/ UICC staging system, and the NCCN guidelines as one of the key factors in treatment decision. Both pathologists and clinicians need to fully understand the principles and practice of this grading system. We here briefly review the historical aspects of the original scheme and the recent developments of Gleason grading system, focusing on major changes over the years that resulted in the modern Gleason grading system, which has led to a new ＂Grade Group＂ system proposed by the 2014 ISUP consensus, and adopted by the 2016 WHO classification of tumours of the prostate.展开更多
目的探讨影像诊断淋巴结包膜外侵犯(radiologic extranodal extension,rENE)与前列腺癌(prostate cancer,PCa)Gleason评分、国际泌尿病理协会(International Society of Urological Pathology,ISUP)分级分组的相关性。材料与方法本研究...目的探讨影像诊断淋巴结包膜外侵犯(radiologic extranodal extension,rENE)与前列腺癌(prostate cancer,PCa)Gleason评分、国际泌尿病理协会(International Society of Urological Pathology,ISUP)分级分组的相关性。材料与方法本研究为单中心研究,回顾性分析了空军军医大学西京医院2017年1月至2021年6月收治的90例N1期PCa患者病例,根据有无rENE表现分为rENE+与rENE−两组,其中rENE+组67例,rENE−组23例。采用Wilcoxon检验分析组间差异,计算两组间ISUP分级分组的相对风险(relative risk,RR)值,采用Spearman相关系数分析rENE与Gleason评分和ISUP分级分组的相关性。结果两组间Gleason评分和ISUP分级分组差异有统计学意义(P<0.01)。rENE+组患者ISUP 5的风险是rENE−组的2.6倍(RR=2.6,95%CI:1.477~3.676),rENE组患者ISUP≤3的可能是rENE+组的17.4倍(RR=17.4,95%CI:4.2~72.3)。Gleason评分、ISUP分级分组与rENE影像表现呈正相关,相关系数分别为0.547(95%CI:0.363~0.688)、0.570(95%CI:0.367~0.716)。结论rENE与PCa患者Gleason评分、ISUP分级分组正相关,相较于rENE−患者,rENE+患者的原发灶恶性程度更高。rENE有望用于无创评估前列腺癌的恶性程度。展开更多
目的:探讨肾透明细胞癌(clear cell renal cell carcinoma,CCRCC)64排多层螺旋CT直接征象与病理学分级之间的相关性,并进行对比分析。方法:收集2015年2月—2018年5月期间安徽省黄山市人民医院经手术切除后病理学检查证实为CCRCC的34例患...目的:探讨肾透明细胞癌(clear cell renal cell carcinoma,CCRCC)64排多层螺旋CT直接征象与病理学分级之间的相关性,并进行对比分析。方法:收集2015年2月—2018年5月期间安徽省黄山市人民医院经手术切除后病理学检查证实为CCRCC的34例患者,分析其术前64排多层螺旋CT平扫及多期增强扫描图像。CCRCC的直接征象包括肿瘤形态、大小、密度、强化方式、强化程度及是否有假包膜等,并与术后病理学分级进行对比。根据世界卫生组织(World Health Organization,WHO)/国际泌尿病理学会(International Society of Urological Pathology,ISUP)病理学分级标准,将CCRCC分为Ⅰ～Ⅳ级,其中Ⅰ～Ⅱ级定义为低级别组(n=28),Ⅲ～Ⅳ级定义为高级别组(n=6),采集相关数据,进行分析。结果:与低级别组CCRCC相比,高级别组CCRCC病灶形状更不规则(高级别组中不规则形肿块3例,占50.0%;低级别组中不规则肿块2例,占7.1%);平扫时肿瘤密度更高(高级别组中5例呈稍高密度,占83.3%;低级别组中仅3例呈稍高密度,占10.7%);增强扫描皮髓交界期肿瘤强化程度较弱[高级别组强化值与同侧正常肾皮质强化值平均差为(-16.1±12.3)HU,低级别组强化值与同侧正常肾皮质强化值平均差为(7.0±7.5)HU];实质期强化衰减程度较低[高级别组肿瘤平均强化衰减值为(-7.7±5.4)HU,低级别组肿瘤平均强化衰减值为(-17.3±7.3)HU]。两组间差异有统计学意义(P<0.05)。结论:CCRCC的64排多层螺旋CT直接征象中,肿瘤形态、平扫密度、皮髓交界期肿瘤强化程度及实质期肿瘤强化减退程度等对判断其WHO/ISUP病理学分级具有一定价值,能为术前确定CCRCC治疗方案提供帮助。展开更多
文摘术前预测透明细胞肾细胞癌(clear cell renal cell carcinoma,ccRCC)的分级可有效评估患者的预后并指导临床治疗,但实现精准预测是目前本领域内的一项重要问题。该研究首先确定最优建模的CT类型与网络层数,提出了一种基于改进残差网络的ccRCC的CT影像分级模型,具体包括:利用大卷积操作对图像进行原始特征提取,利用混合注意力模块通过计算特征图中当前空间和临近空间以及当前空间和远距离空间之间的信息交互获取更多有用的特征,使得原始图像特征图在通道维度与空间维度上进行自适应特征细化,利用四个深度卷积网络层提取图像深度特征,并利用改进通道注意力模块产生通道注意力特征图信息,提取更多通道上的交互信息。实验结果表明,增强CT实质期图像和34层残差网络最有利于分级预测模型的开发,所提出的模型的总体加权准确率、AUC、精度、召回率和F1分数分别为90.8%、0.897、90.5%、90.8%、90.9%,各项指标优于其他常见网络结构,因此,该模型在预测ccRCC的国际泌尿病理学学会(International Society of Urological Pathology,ISUP)分级方面有良好的效能,对患者的临床辅助诊断和预后治疗具有重要的理论指导意义。
基金This work was supported by the Natural Science Foundation of China （NSFC 81172439, 81272820, and 81402110）.
文摘We compared the predictive ability of the 2014 and 2005 Gleason grading systems in 568 patients initially diagnosed with metastatic prostate cancer （PCa）. Outcomes included the duration of castration-resistant prostate cancer-free survival （CFS） and overall survival （OS）. Univariate analyses and log-rank tests were used to identify prognosis indicators and assess univariable differences in CFS and OS in Gleason score （GS） groups. Cox proportional hazards and area under the curves of receiver operator characteristics methods were used to evaluate the predictive efficacy of the 2005 and 2014 ISUP grading systems. Univariate analyses showed that the 2005 and 2014 grading systems were prognosticators for CFS and OS; both systems could distinguish the clinical outcome of patients with GS 6, GS 7, and GS 8-10. Using the 2014 criteria, no statistical differences in patient survival were observed between GS 3 ＋ 4 and GS 4 ＋ 3 or GS 8 and GS 9-10. The predictive ability of the 2014 and 2005 grading systems was comparable for CFS and OS （P = 0.321）. However, the 2014 grading system did not exhibit superior predictive efficacy in patients initially diagnosed with PCa and bone metastasis; trials using larger cohorts are required to confirm its predictive value. To the best of our knowledge, ours is the first study to compare the 2005 and 2014 grading systems in initially diagnosed PCa with bone metastasis. At present, we recommend that both systems should be used to predict the prognosis of patients with metastatic PCa.
基金supported by grants from the Natural Science Foundation of China (NSFC 81272848, 81272820, 81302225, 81572540)
文摘The Gleason grading system for prostate adenocarcinoma has evolved from its original scheme established in the 1960s-1970s, to a significantly modified system after two major consensus meetings conducted by the International Society of Urologic Pathology （ISUP） in 2005 and 2014, respectively. The Gleason grading system has been incorporated into the WHO classification of prostate cancer, the AJCC/ UICC staging system, and the NCCN guidelines as one of the key factors in treatment decision. Both pathologists and clinicians need to fully understand the principles and practice of this grading system. We here briefly review the historical aspects of the original scheme and the recent developments of Gleason grading system, focusing on major changes over the years that resulted in the modern Gleason grading system, which has led to a new ＂Grade Group＂ system proposed by the 2014 ISUP consensus, and adopted by the 2016 WHO classification of tumours of the prostate.
文摘目的探讨影像诊断淋巴结包膜外侵犯(radiologic extranodal extension,rENE)与前列腺癌(prostate cancer,PCa)Gleason评分、国际泌尿病理协会(International Society of Urological Pathology,ISUP)分级分组的相关性。材料与方法本研究为单中心研究,回顾性分析了空军军医大学西京医院2017年1月至2021年6月收治的90例N1期PCa患者病例,根据有无rENE表现分为rENE+与rENE−两组,其中rENE+组67例,rENE−组23例。采用Wilcoxon检验分析组间差异,计算两组间ISUP分级分组的相对风险(relative risk,RR)值,采用Spearman相关系数分析rENE与Gleason评分和ISUP分级分组的相关性。结果两组间Gleason评分和ISUP分级分组差异有统计学意义(P<0.01)。rENE+组患者ISUP 5的风险是rENE−组的2.6倍(RR=2.6,95%CI:1.477~3.676),rENE组患者ISUP≤3的可能是rENE+组的17.4倍(RR=17.4,95%CI:4.2~72.3)。Gleason评分、ISUP分级分组与rENE影像表现呈正相关,相关系数分别为0.547(95%CI:0.363~0.688)、0.570(95%CI:0.367~0.716)。结论rENE与PCa患者Gleason评分、ISUP分级分组正相关,相较于rENE−患者,rENE+患者的原发灶恶性程度更高。rENE有望用于无创评估前列腺癌的恶性程度。
文摘目的:探讨肾透明细胞癌(clear cell renal cell carcinoma,CCRCC)64排多层螺旋CT直接征象与病理学分级之间的相关性,并进行对比分析。方法:收集2015年2月—2018年5月期间安徽省黄山市人民医院经手术切除后病理学检查证实为CCRCC的34例患者,分析其术前64排多层螺旋CT平扫及多期增强扫描图像。CCRCC的直接征象包括肿瘤形态、大小、密度、强化方式、强化程度及是否有假包膜等,并与术后病理学分级进行对比。根据世界卫生组织(World Health Organization,WHO)/国际泌尿病理学会(International Society of Urological Pathology,ISUP)病理学分级标准,将CCRCC分为Ⅰ～Ⅳ级,其中Ⅰ～Ⅱ级定义为低级别组(n=28),Ⅲ～Ⅳ级定义为高级别组(n=6),采集相关数据,进行分析。结果:与低级别组CCRCC相比,高级别组CCRCC病灶形状更不规则(高级别组中不规则形肿块3例,占50.0%;低级别组中不规则肿块2例,占7.1%);平扫时肿瘤密度更高(高级别组中5例呈稍高密度,占83.3%;低级别组中仅3例呈稍高密度,占10.7%);增强扫描皮髓交界期肿瘤强化程度较弱[高级别组强化值与同侧正常肾皮质强化值平均差为(-16.1±12.3)HU,低级别组强化值与同侧正常肾皮质强化值平均差为(7.0±7.5)HU];实质期强化衰减程度较低[高级别组肿瘤平均强化衰减值为(-7.7±5.4)HU,低级别组肿瘤平均强化衰减值为(-17.3±7.3)HU]。两组间差异有统计学意义(P<0.05)。结论:CCRCC的64排多层螺旋CT直接征象中,肿瘤形态、平扫密度、皮髓交界期肿瘤强化程度及实质期肿瘤强化减退程度等对判断其WHO/ISUP病理学分级具有一定价值,能为术前确定CCRCC治疗方案提供帮助。
