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首页> 外文期刊>British Journal of Cancer >New prostate cancer grade group system correlates with prostate cancer death in addition to biochemical recurrence
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New prostate cancer grade group system correlates with prostate cancer death in addition to biochemical recurrence

机译：除生化复发外，新的前列腺癌分级组系统还与前列腺癌死亡相关

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The study by Berney et al (2016) is an important work correlating prostate cancer death with the new 5 Grade Group system for prostate cancer. The novel Grade Group system was first proposed by the group from Johns Hopkins Hospital in 2013 ( Pierorazio et al , 2013 ) and subsequently validated with a multi-institutional study by Epstein et al (2016a) of over 20?000 men treated by radical prostatectomy and over 5000 men who underwent radiation therapy using biochemical recurrence as the end point. The study by Berney et al (2016) is the first to demonstrate that the 5 Grade Groups also correlate well with death due to prostate cancer, further validating the veracity of the new grading system. As noted by the authors, there are inherent weaknesses in the Transatlantic Prostate Group cohort used in the Berney et al study, as cases were included from as far back as 1990, when diagnosis and treatment of prostate cancer was very different than current practice. For example, sextant core biopsy was the most common biopsy technique used in the study by Berney et al (2016) , which is now recognised as suboptimal sampling of the prostate. However, the advantage of using these older cases is that there is sufficient follow-up that the study could assess death from prostate cancer. This study also evaluates the controversial issue of whether the extra effort of calculating average grade on biopsy when there are multiple different cores with different grades adds significantly to predict prognosis as opposed to using the highest grade. In the United States, the typical practice is to assign a grade to each involved core and leave it up to the clinician to determine the grade used for treatment and prognosis, typically the core with the highest grade. The highest grade on a given core has been used for generating popular predictive and prognostic tools, such as the Kattan nomograms and the Partin tables. However, some pathologists in other countries have advocated for adding all the positive cores together as if it was one long core to determine the ‘average' or ‘global' Gleason score for the case. A more complicated and subjective variation on ‘average' Gleason score has been proposed by some pathologists where there they average together only some of the positive cores together based on their location and grade in an attempt to determine which is the dominant tumour nodule grade ( Arias-Stella et al , 2015 ). It is my practice to give the individual core grades and leave it up to the clinician to determine the grade for treatment and prognosis. It may be the highest grade on a given core or the clinician may have information on the dominant tumour location by multiparametric MRI and targeted biopsies, which could be factored in for determining the dominant tumour nodule grade. The pathologist does not always have access to the results of imaging procedures. The study by Berney et al (2016) demonstrates that using the worst grade in a case, as opposed to the ‘average' grade, resulted in greater separation of Grade Groups 3 and 4. The worst grade was also used in both the initial and validating studies of Grade Groups ( Pierorazio et al , 2013 ; Epstein et al , 2016a ), which showed significant differences in biochemical recurrence between Grade Groups 3 and 4. Berney et al (2016) add to the growing body of literature on the validity of the new simplified Grade Group system for prostate cancer. There are several advantages of the new system. First, it is a more accurate grade stratification than current applications of the Gleason system. The second major benefit of the new grading system is it is simple and intuitive, ranging from 1 to 5 as opposed to the current application of the Gleason system which in practice ranges from 6 to 10, and includes 7 that is separated into 3+4=7 and 4+3=7. The new grading system and its terminology ‘Grade Groups 1–5' were also adopted by the 2016 Edition of the World Health Organization of the Pathology and Genetics: Tumours of the Urinary System and Male Genital Organs. For the foreseeable future to ease the transition to the new grading system, it was agreed upon that both the Gleason grade and the Grade Groups would be included in pathology reports ( Epstein et al , 2016b ).
机译：Berney等人（2016）的研究是一项重要工作，将前列腺癌死亡与新的5级前列腺癌系统相关联。新的成绩组系统由Johns Hopkins医院的团队在2013年提出（Pierorazio等人，2013年），随后由Epstein等人（2016a）对超过20万名接受前列腺癌根治术的男性进行了多机构研究验证超过5000名以生化复发为终点进行放射治疗的男性。 Berney等人（2016）的研究首次证明了5个等级组也与前列腺癌导致的死亡密切相关，进一步证实了新等级系统的准确性。正如作者所指出的那样，Berney等人研究中所使用的跨大西洋前列腺小组研究小组存在固有的弱点，因为早在1990年就纳入了病例，当时前列腺癌的诊断和治疗与目前的做法大不相同。例如，六分体核心活检是Berney等（2016）研究中使用的最常见的活检技术，现已被认为是前列腺的次佳取样。但是，使用这些较老病例的好处是，有足够的随访资料可以使研究评估前列腺癌的死亡。这项研究还评估了一个有争议的问题，即当存在多个具有不同等级的不同核心时，额外的计算活检平均等级的努力是否显着增加了预测预后，而不是使用最高等级。在美国，通常的做法是为每个涉及的核心指定一个等级，然后由临床医生确定用于治疗和预后的等级，通常是最高等级的核心。给定核的最高等级已用于生成流行的预测和预后工具，例如Kattan nomograms和Partin表。但是，其他国家/地区的某些病理学家则主张将所有积极的核心加在一起，就好像确定该病例的“平均”或“全球”格里森得分是一个长期核心。一些病理学家提出了“平均”格里森评分的更复杂和主观的变化，他们根据位置和等级仅将一些阳性核心平均在一起，试图确定哪个是占主导地位的肿瘤结节等级（Arias -Stella等人，2015年）。我的做法是给出各个核心等级，然后由临床医师确定治疗和预后等级。它可能是给定核心上的最高级别，或者临床医生可能会通过多参数MRI和靶向活检获得有关优势肿瘤位置的信息，这些信息可用于确定优势肿瘤结节级别。病理学家并非总是可以获取成像程序的结果。 Berney等人（2016）的研究表明，在案例中使用最差的成绩，而不是“平均”成绩，导致第3和第4级成绩之间的距离更大。验证等级组的研究（Pierorazio等人，2013; Epstein等人，2016a），该研究表明第3和第4年级组在生化复发方面存在显着差异。Berney等人（2016）增加了关于等级组有效性的文献。新的简化的前列腺癌分级组系统。新系统有几个优点。首先，它比格里森系统的当前应用程序更准确的等级分层。新评分系统的第二个主要优点是它简单直观，范围从1到5，而Gleason系统的当前应用范围是6到10，包括7分成3 + 4 = 7和4 + 3 = 7。新的分级系统及其术语“ 1-5级组”也被世界卫生组织病理与遗传学杂志（2016年版）采用：泌尿系统和男性生殖器官肿瘤。为了在可预见的将来简化向新等级系统的过渡，人们同意将格里森等级和等级组都包括在病理报告中（Epstein等，2016b）。

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