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DOI: 10.1055/s-0030-1247306
© Georg Thieme Verlag Stuttgart ˙ New York
Die Übereinstimmung des Gleason-Scores in Prostatabiopsie und definitiver Histologie
Concordance of the Gleason Score in Prostate Multibiopsy and Definitive HistologyPublikationsverlauf
Publikationsdatum:
22. März 2010 (online)
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Zusammenfassung
Hintergrund: Aufgrund der unzureichenden mittleren Übereinstimmung des Gleason-Scores (GS) in Biopsie und Prostatektomiepräparat von nur etwa 45 % erfolgte im Jahr 2005 eine Modifikation des GS, die u. a. zu einer Eliminierung des GS 2–4 in der Biopsie führte. Ziel der vorliegenden Studie bildete neben der Untersuchung der Übereinstimmung von GS und WHO-Grading in Stanzbiopsie und definitiver Histologie außerdem die Ermittlung von Faktoren, die mit der Genauigkeit der Biopsiediagnose und der Prognose interferieren. Material und Methode: Innerhalb eines 10-Jahres-Zeitraums vor Modifikation des GS wurde bei 856 Patienten mit Prostatakarzinom (Studiengruppe, SG; mittleres Alter: 64,2 Jahre) eine radikale Prostatektomie durchgeführt. Der Übereinstimmungsgrad von GS bzw. WHO-Grading in Biopsie und definitiver Histologie wurde mittels Kappa-Statistik (κ) berechnet (gesamt und innerhalb von 3 Zeiträumen). Weiterhin wurde der uni- und multivariate Einfluss verschiedener prätherapeutischer Variablen auf das rezidivfreie Überleben geprüft. Der mittlere Nachbeobachtungszeitraum der SG betrug 39 (10–139) Monate. Ergebnisse: Das Undergrading nahm für Gleason-Score und WHO-Grading innerhalb der 3 Zeiträume kontinuierlich zugunsten einer größeren Übereinstimmung zwischen histologischem Befund der Biopsie und definitiver Histologie ab. Dennoch zeigte sich im gesamten Untersuchungszeitraum nur eine schlecht-moderate Übereinstimmung (κ-Wert 0,354 für den GS und 0,404 für das Grading), die sowohl für GS als auch Grading durch eine Erhöhung der Anzahl entnommener Stanzzylinder verbessert werden konnte. Einen unabhängigen Einfluss auf das rezidivfreie Überleben zeigten PSA-Wert, klinisches Tumorstadium, Anteil positiver Biopsien (Dichotomisierung bei 34 %), Fallmenge an RPEs per annum (Dichotomisierung bei 75) und Biopsie-GS. Patienten mit GS 2–4 in der Biopsie wiesen in nur 5,7 % ein Upgrading hin zu einem GS ≥ 7 auf und hatten, unabhängig von ihrem GS in der definitiven Histologie, eine signifikant bessere Prognose als Patienten mit höherem Gleason-Score. Schlussfolgerungen: Die Ergebnisse beweisen erneut die unabhängige prognostische Signatur des GS in der Biopsie. Die Übereinstimmung mit der definitiven Histologie ist allerdings unzureichend und kann durch Erhöhung der Zahl der entnommenen Stanzzylinder verbessert werden. Der aus Sicht des Pathologen verständliche Verzicht auf die Diagnosestellung eines Gleason-Scores 2–4 in der Biopsie führt zu einem erheblichen Verlust prognoserelevanter prätherapeutischer Informationen.
Abstract
Background: Due to an insufficient mean agreement between the Gleason score (GS) revealed from multibiopsy and definitive histology after radical prostatectomy (RP) of merely about 45 %, a modification of the GS including an elimination of GS 2–4 was accomplished in 2005. The aim of the present study was to evaluate the concordance of GS and WHO grading in biopsy and definitive histology and to determine parameters influencing the diagnostic accuracy of the biopsy and the prognosis. Materials and Methods: Within a 10-year-period before modification of the GS, radical prostatectomy was performed in 856 patients (study group, SG; mean age 64.2 years). The grade of agreement between GS and WHO grading in biopsy and definitive histology was calculated by kappa statistics (κ) (for the complete and single time periods). Furthermore, we assessed the univariable and multivariable influence of different preoperatively available parameters on disease-free survival (DFS). The mean follow-up period was 39 months (range: 10–139 months). Results: Undergrading of GS and WHO grading decreased continuously within the three time periods in favour of a higher agreement regarding the histological results revealed from biopsy and definitive histology. However, we found only a poor to moderate agreement in the complete time period (κ values of 0.354 for GS and 0.404 for WHO grading) that – with regard to both parameters – was improved by an increased number of biopsy cores taken. PSA value, clinical tumour stage, number of positive cores (dichotomised at 34 %), annual RP case load (dichotomised at 75), and GS revealed an independent significant influence on DFS. Patients with GS 2–4 in the biopsy exhibited an upgrade to GS ≥ 7 in only 5.7 %, and showed, independent of the definitive histology, a significantly better prognosis in comparison with patients presenting with a higher GS. Conclusions: The results of the present study again suggest the independent prognostic impact of the GS revealed from biopsy. However, the concordance with the GS in the definitive histology remains deficient and is improvable by taking a higher number of biopsy cores. Although the elimination of GS 2–4 might be comprehensible for the pathologist’s purpose, it results in a considerable loss of pretherapeutic prognostic information.
Schlüsselwörter
Prostatakarzinom - radikale Prostatektomie - Gleason-Score - WHO-Grading - Zeittrends - Prognose
Key words
prostate cancer - radical prostatectomy - Gleason score - WHO grade - time trends - prognosis
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1 M. May und S. Brookman-May waren zu gleichen Teilen an der Entstehung des Manuskripts beteiligt.
Dr. med. M. May
Urologische Klinik · Klinikum St. Elisabeth Straubing
St.-Elisabeth-Str. 23
94315 Straubing
Telefon: 0 94 21 / 7 10 17 01
Fax: 0 94 21 / 7 10 17 17
eMail: matthias.may@klinikum-straubing.de