穿刺标本Gleason评分预测前列腺癌病理分级准确性的研究

目的 分析前列腺癌患者穿刺标本与根治术标本Gleason评分的相关性,探讨影响穿刺标本Gleason评分准确性的可能因素.方法 回顾性分析86例接受根治性前列腺切除术的前列腺癌患者资料,比较穿刺标本与根治术标本Gleason评分的符合情况,应用二分类Logistic回归分析筛选影响穿刺标本Gleason评分准确性的可能因素.结果 86例患者穿刺标本平均Gleason评分为6.1,根治术标本平均Gleason评分为6.5,穿刺标本与根治术标本Gleason评分相比,评分相符42例(48.8%),评分偏低32例(37.2%),评分偏高1 2例(14.0%),差异具有统计学意义(P＜0.05),偏差与患者年龄、血清PSA、前列腺体积、临床分期无显著相关性(P＞0.05),与穿刺针数(OR=2.905)及穿刺阳性率(OR=4.225)有显著相关(P＜0.05).结论 穿刺针数与穿刺阳性针数百分比是影响穿刺标本Gleason评分准确性的可能因素,增加前列腺穿刺活检针数将可能有助于提高穿刺标本预测前列腺癌病理分级的准确性.     

增加穿刺活检针数提高前列腺癌分级准确性的临床研究

目的 探讨增加穿刺活检针数能否提高前列腺癌穿刺标本Gieason评分准确性.方法 接受根治性前列腺切除的前列腺癌患者86例.平均年龄63(55～72)岁.术前PSA值平均16.8(1.6～57.2)ng/ml,前列腺体积平均39.4(18.1～114.1)ml.患者术前均未接受新辅助内分泌治疗,按经直肠前列腺穿刺针数分为2组.A组46例行标准6针系统穿刺,B组40例行13针系统穿刺.统计学比较分析2组穿刺标本与根治术标本Gleason评分符合情况及影响因素. 结果 A组穿刺标本与根治术标本Gleason评分相符16例(34.8%),B组为26例(65.O%),B组评分符合率明显高于A组(P＜0.05).当穿刺标本Gleason评分≤6时,B组评分相符11例(68.8%),明显高于A组5例(25.0%),差异有统计学意义(P＜0.05).多因素Logistic回归分析结果提示前列腺穿刺活检针数及活检阳性率是影响穿刺标本与根治术标本Gieason评分符合率的主要相关因素(P＜0.05).结论 增加穿刺针数能够提高经直肠前列腺穿刺标本Gleason评分预测前列腺癌分级的准确性.     

ISUP版Gleason评分在前列腺癌根治术后评分升级的影响因素分析

目的:探讨前列腺癌根治术后标本较前列腺穿刺活检标本Gleason评分升级的影响因素。方法:回顾性分析2012年1月至2015年6月接受前列腺穿刺活检确诊为前列腺癌并行根治性切除的235例患者年龄、术前PSA、前列腺体积、PSA密度(PSAD)、穿刺至手术间隔时间、穿刺阳性针数、切缘情况、精囊侵犯、淋巴转移等指标,统计其穿刺和术后Gleason评分的差异。运用Logistic回归分析引起术后Gleason评分升级的危险因素。结果:164例患者纳入分析,其中术前穿刺与根治术后标本Gleason评分相符有95例(57.93%),术后上升55例(33.54%),下降14例(8.52%)。前列腺体积(P0.01)和穿刺评分(P0.05)是影响根治术后标本Gleason评分升级的独立预测因子,其中前列腺体积≤25 ml组其术后Gleason评分升高的风险是体积60 ml组的27倍(P0.05),前列腺体积25~40 ml组术后Gleason评分升高的风险是体积60 ml组的9倍(P0.05)。结论:穿刺Gleason评分≤6、小体积前列腺(≤40 ml),术后Gleason评分升级可能性大。     

前列腺癌分期方法的临床评价

目的 :探讨临床参数对前列腺癌分期的临床意义。　方法 :通过病理诊断、MRI检查及全身骨扫描对 112例经前列腺活检病理证实的前列腺癌进行分期 ,结合血清前列腺特异抗原 (PSA)、穿刺后Gleason评分、穿刺阳性针数百分率评价其临床意义。　结果 :112例前列腺癌中 ,血清PSA、Gleason评分、穿刺阳性针数百分率对前列腺癌分期有显著相关性 (r=0 .6 98,r=0 .6 74 ,r=0 .6 71,P均 <0 .0 0 1) ,但对B期和C期前列腺癌的诊断差异无显著性 (χ2=2 .6 75 ,P =0 .0 96 ;χ2 =0 .70 4 ,P =0 .4 0 1) ,血清PSA较Gleason评分和穿刺阳性针数百分率对D期的诊断差异有显著性 (χ2 =5 .135 ,P =0 .0 2 3;χ2 =4 .5 93,P =0 .0 32 )。血清PSA、Gleason评分和穿刺阳性针数百分率的敏感性分别为 76 .7%、83.3%和 77.8% ,特异性为 5 0 %、77.3%和 5 4 .5 % ,准确性为 71.4 %、82 .1%和 73.2 %。　结论 :血清PSA、Gleason评分、穿刺阳性针数百分率可预测前列腺癌的分期 ,穿刺后Gleason评分对前列腺癌分期的预测较血清PSA和穿刺阳性针数百分率更准确。血清PSA对远处转移性前列腺癌的预测更有意义     

前列腺穿刺单针阳性的临床特点

目的通过对前列腺穿刺单针阳性并行腹腔镜前列腺癌根治术患者的临床资料进行分析,了解其临床特点及意义。方法收集我院2013年1月至2017年12月进行的1091例前列腺穿刺中穿刺单针阳性确诊为前列腺癌并行腹腔镜前列腺癌根治术的44例患者的临床、病理及随访资料进行分析,并对Gleason评分升级的相关因素进行分析。结果 44例单针穿刺阳性前列腺癌的根治标本中,以前列腺根治标本Gleason为标准,穿刺标本Gleason与其一致的有25例(56.8%),评分升高的有17例(38.6%),评分降低的有2例(4.5%),手术切缘阳性13例(29.5%);统计分析显示患者年龄、PSA、f PSA/TPSA、PSAD、前列腺体积与前列腺根治术后Gleason评分升级无明显相关。术后行内分泌治疗者均未发现生化复发,其余患者术后PSA均未升高。结论前列腺单针穿刺阳性者Gleason评分以低危为主,但根治术后Gleason评分升高的风险较高,肿瘤负荷存在被低估的可能,需引起临床重视,目前尚无有效的指标用于预测Gleason评分升级。     

前列腺穿刺活检与根治切除病理的相关性分析

目的评价前列腺穿刺活检下前列腺癌(prostatic cancer,PCa)患者Gleason评分对肿瘤发生部位预测的可靠性,分析根治术后出现切缘阳性(positive surgical margins,PSM)的相关影响因素。方法前列腺癌患者72例,术前均行前列腺穿刺活检,并与根治切除术后的病理进行对比分析,应用统计软件分析各指标间的相关性。结果穿刺病理与根治切除病理的Gleason评分基本一致;穿刺阳性多集中在外周靠近底部的4点,穿刺结果提示的肿瘤分布与根治病理的肿瘤分布一致性较差。术前相关临床指标中,穿刺Gleason评分及穿刺阳性针数百分比对切缘阳性有独立的预测意义,穿刺各针中F、L两点与切缘阳性存在较高的相关性。结论前列腺穿刺Gleason可作为患者病理分级的有效依据;当穿刺Gleason评分7.25,阳性针数比例45.0%,穿刺阳性位置靠近前列腺尖部时手术后出现切缘阳性的可能性增加。     

前列腺穿刺活检针数与根治手术标本病理之间的相关性:是否与最终病理结果一致?

<正>目的:评估超声引导下经直肠穿刺活检针数能否精确预测前列腺根治术后标本的病理参数如Gleason评分、发生上皮内瘤变及神经浸润。材料与方法:研究对象是99例接受过前列腺癌根治术的患者。我们将活检针数与穿刺用于诊断的组织和前列腺癌根治术后的组织的病理参数进行比较。结果:在不考虑穿刺活检针数的情况下,超声引导下经直肠穿刺活检标本与前列腺癌根治术后标本的Gleason评分、前列腺上皮内瘤变及神经浸     

超声引导下经直肠前列腺穿刺与前列腺癌根治术后病理组织Gleason评分差异性的研究

目的:比较超声引导下经直肠前列腺穿刺活检病理组织Gleason评分与前列腺癌根治术后病理Gleason评分的差异。方法:回顾性分析比较青岛市立医院2009年2月~2014年11月间行前列腺癌根治术的66例患者术前10+X穿刺活检Gleason评分、术后Gleason评分及其差异性。结果:66例患者中,高分化癌(Gleason评分2~4分)0例,中分化癌(Gleason评分5~6分)13例(19.7%),低分化癌(Gleason评分7~10分)53例(80.3%);前列腺穿刺标本与根治术后标本Gleason评分符合率为51.5%,评分偏低39.4%,评分偏高9.1%。按前列腺癌分级分组整体评价,Gleason评分符合率分别为3~6分34.5%,7分75.0%,8~9分33.3%。结论:应用穿刺活检Gleason评分指导临床治疗方案和判断预后较为可靠,但临床医生仍需考虑到其局限性。     

前列腺癌根治术后Gleason评分升级与术前多参数MRI PI-RADS评分的关系

目的探讨前列腺癌根治术后Gleason评分升级与术前多参数MRI(mpMRI)前列腺影像报告数据系统(PIRADS)评分的关系。方法回顾性分析198例前列腺癌根治术后患者的资料。根据PI-RADS评分分为低分(1~2分),中分(3分),高分(≥4分)3组。通过单因素和多因素Logistic回归分析探讨PI-RADS评分与Gleason评分的关系。结果单因素分析显示,前列腺特异性抗原密度、前列腺体积、术前穿刺病理Gleason评分、精囊侵犯、穿刺阳性针数、PI-RADS评分是术后Gleason评分升级的影响因子(P均0.05)。多因素分析显示,前列腺体积(P0.01)与术前PI-RADS评分(P0.01)是前列腺癌根治术后Gleason评分升级的独立预测因素。术前PI-RADS评分低分组及中分组术前与术后Gleason评分差异无统计学意义(P均0.05);而高分组术后Gleason评分高于术前,差异有统计学意义(P0.05)。结论术前Gleason评分较低(≤6分)而PI-RADS评分较高(≥4分)的小体积前列腺癌患者,术后Gleason评分升级的可能大。     

前列腺癌根治术后Gleason评分升级相关危险因素分析

目的探讨前列腺癌根治术后Gleason评分升级的相关危险因素。方法回顾性分析2014年8月至2016年9月175例行前列腺癌根治术患者的年龄、前列腺特异性抗原PSA、前列腺体积、穿刺阳性针数和穿刺癌组织最大占比等指标,统计穿刺与根治术后Gleason评分差异,并应用Logistic回归分析前列腺癌根治术后Gleason评分升级的危险因素。结果 175例患者中,44例(25.1%)出现术后病理Gleason评分较穿刺前升高。前列腺体积是前列腺癌根治术后Gleason评分升级的独立预测因素。结论前列腺体积较小的前列腺癌患者,术后Gleason评分发生升级的可能性较大。     

Histologic grading of primary prostatic carcinoma--study of Gleason histologic grading

Gleason histologic grading for prostatic carcinoma was evaluated in a retrospective analysis. The present study comprises 98 cases of prostatic adenocarcinoma followed from January, 1973 to December, 1985. Histological materials were obtained by needle biopsy, transurethral resection or by suprapubic prostatectomy. Such slides were examined by a pathologist without previous knowledge of the patients and were assigned according to the General Rules for Clinical and Pathological Studies on Prostatic Cancer (1985) or Gleason system. Most patients fell within a Gleason score of 6, 7 and 8, and had a correspondingly high stage tumors. The survival rate for the patients was analyzed according to Gleason score. Because of the small numbers of patients some scores were combined. There were no cancer deaths for the 15 patient with a Gleason score under 5. Patients with a higher score (9-10) had a poorer prognosis (32% of survival rate at 2,234 days), but there was no significant correlation between a Gleason score of 6, 7 or 8, or that of a higher score (9-10) and survival rate.     

Classification, histologic and cytologic grading and regression grading of prostate cancer

The submitted recommendation of the pathologic- urologic team "prostatic carcinoma" is the result of several meetings, in order to provide a basis for a uniform nomenclature in diagnosis, therapy, and prognosis of prostatic carcinoma to urologists and pathologists in practice.     

Solid organ injury grading in trauma: accuracy of grading by surgical residents

The American Association for the Surgery of Trauma developed an Organ Injury Scale for management of patients with splenic, kidney, or liver injuries. Despite widespread use of the guidelines, the person who determines the injury grade varies among institutions. Our purpose was to determine the accuracy and interobserver agreement between surgical residents and a radiologist in grading solid organ injuries. We retrospectively reviewed patients with solid organ injuries from January 2009 to May 2010 and compared the grade of solid organ injuries by a single resident with grades by a single blinded radiologist using a paired t test, analysis of variance, or Kruskal-Wallis. Computed tomography scans of 58 patients with splenic injuries, 43 with liver injuries, and 16 with kidney injuries were reviewed. Average grades for splenic injuries were 2.5 and 2.4 (radiologist/resident); liver injuries, 2.6 and 2.1; and kidney injuries, 2.7 and 2.8. There were no significant differences in grading by the radiologist and resident for splenic and kidney injuries; however, equal values were only achieved in 43 and 38 per cent, respectively. There was a significant difference (average rating difference 0.54, P = 0.0002) in grading between the radiologist and resident for liver injuries with only 35 per cent having equal values and the radiologist grading on average 0.5 points higher than the resident. No demographic, injury, or outcome variables were significantly associated with interobserver variability (P > 0.05). Despite a significant difference for liver injury grading, interobserver agreement between residents and a single radiologist was low. Clinical implications and the impact on outcomes related to interobserver variations require further study.     

Correlation between histologic grading and prognosis of prostatic cancer--comparing the grading system of the Japanese general rules of prostatic cancer with Gleason's grading

To evaluate the correlation between the histological grade and the prognosis, we reviewed 100 cases of prostatic cancer according to the Japanese General Rules of Prostatic Cancer (JGRPC) and Gleason grading system. The study led to the following results: (1) There was a close relation between the JGRPC grade and Gleason score (GS). (2) The JGRPC grade and Gleason score were equally concerned with the clinical stage. (3) There were significant differences in survival rate between well and moderately, well and poorly differentiated groups by the JGRPC grading system, and between GS 2-4 and GS 5-7, GS 2-4 and GS 8-10 groups by Gleason score. (4) In proportion to the JGRPC grade, the cancer death rate increased linearly in each stage. (5) When the patients were grouped according to their JGRPC grades of main lesion and accompanied lesion, the cancer death rate increased in the cases with lower differentiated elements. We conclude that the JGRPC grading system is easily comprehensible, and equal with the Gleason grading system to predict the prognosis of prostatic cancer.     

Problems in grading of prostatic carcinoma: interobserver reproducibility of five different grading systems

Summary In order to investigate the reproducibility of grading systems for prostatic carcinoma currently in use, a comparative histological grading study was done. These studies were carried out on tissue sections from radical prostatectomy specimens (N=50) stained with hematoxylin and eosin. Five pathologists with varying professional experience participated in the study, using five different grading systems: those of Broders, Brawn, Gleason (for statistical compilation the modified version), Mostofi, and a modified Mostofi grading method recently described by Schroeder and Mostofi. Weighted kappa coefficients ranged from 0.21 to 0.52. None of the systems investigated demonstrated a high degree of reproducibility (k>0.70). Reproducibility of the systems described by Broders and Brawn was reasonably good (k=0.52 and 0.41, respectively). With the modified Gleason method (rearrangement of Gleason scores into 3 grades), a considerable difference was noted between the numerical agreement score (among at least 3 observers) and the measured kappa value (100% and 0.30, respectively). The methods described by Mostofi and Schroeder-Mostofi revealed only limited reproducibility (k=0.21 and 0.34, respectively).