前列腺腺癌的Gleason评分进展课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,前列腺腺癌的 Gleason评分进展,和新的预后分组,前列腺腺癌的Gleason评分进展前列腺腺癌的 Gleason评分进展,和新的预后分组,纲要,Gleason分级最新进展,Gleason评分规则的应用,新的预后分组信息( New prognostic grading system),WHO CIasefieatian at,WHO classification of Tumour of the Urinary System and Male Genital Organs (2016,Gleason分级最新进展,主要改变的内容有三点,1.对具有特殊组织学形态的前列腺癌 Gleason评分达成一致,如:筛状形态、肾小球样腺体、粘液腺癌,2新增导管内癌(IDGP),3.对前列腺癌亚型的分级,如泡沫状癌,萎缩型癌,假增生型癌、导管腺癌、印戒细胞癌等,前列腺腺癌的 Gleason评分进展前列腺腺癌的Gleaso,1,纲要,Gleason分级最新进展,Gleason评分规则的应用,新的预后分组信息( New prognostic grading system),WHO CIasefieatian at,WHO classification of Tumour of the Urinary System and Male Genital Organs (2016,纲要,2,Gleason分级最新进展,主要改变的内容有三点,1.对具有特殊组织学形态的前列腺癌 Gleason评分达成一致,如:筛状形态、肾小球样腺体、粘液腺癌,2新增导管内癌(IDGP),3.对前列腺癌亚型的分级,如泡沫状癌,萎缩型癌,假增生型癌、导管腺癌、印戒细胞癌等,Gleason分级最新进展,3,Gleason grading system( Gleason分级系统),The most widely used grading system for prostatic adenocarcinoma,Developed in 1966 by Dr Donald Gleason,Based on general histologic appearance(not mitotic count or cell types),5 patterns(patter 1 to pattern 5)( Gleason grade 1 to 5: 5),Further refined in1974,1977,1992,2005,2014,Gleason grading system( Gleaso,4,Gas0n分级量新进展,2015修订版,08,的楼,Wenwen I Youa Media,0 2015Idaa Unl,Gas0n分级量新进展,5,Gleason分级最新进展1,对特殊组织学形态的共,ISUP 2005,ISUP 2014,筛状腺体,小的边界,Gleason3均为 Gleason4(10%,边界不规,的,Gleason,肾小球样没有达成一致意见,Gleason 4(100%),腺体,50%认为是 Gleason4,其余50%认为目前生物学行未,粘液腺癌大约50%专家认为是 Gleason4根据粘液腺癌本身的结构(91%):多数为,其余50%认为根据粘液腺癌的结 Gleason4,少量为3,Gleason分级最新进展1,6,Gleason分级最新进展1,國,ARC,原为Geao3和 Gleason4,现为 gleason4,多数为 Gleason4,少数,现均为 Gleason4,Gleason3,看腺体结构而定,Gleason分级最新进展1,7,Geas0n分级最新进展2,新增导管内癌(IDCP),Intraductal carcinoma of prostate: IDC-P,1985年首先由Ko提出,目前最常用的诊断标准:2006年 Guo and Epstein提出,诊断标准,Malignant epithelial cells filling large acini and prostatic ducts, with preservation of basal cells and either a,solid or dense cribriform pattern or a loose cribriform or micropapillary pattern with either marked nuclear,atypia(nuclear size 6x normal) or comedonecrosis,Geas0n分级最新进展2,8,Geas0n分级最新进展2,粉刺状|DCP,实体型DCP,筛状型DC,Geas0n分级最新进展2,9,Geas0n分级最新进展2,临床意义,根治标本中DCP常与高级别浸润癌共存,与 Gleason评分、肿瘤容积、前列腺外扩散、精囊腺侵犯和淋巴结转移均密切,相关,根治标本中存在DCP为生化复发和总体生存率的独立预测指标,1DCP的存在提示病人更易进展为去势抵抗型或者对放疗不敏感,Geas0n分级最新进展2,10,前列腺腺癌的Gleason评分进展课件,11,前列腺腺癌的Gleason评分进展课件,12,前列腺腺癌的Gleason评分进展课件,13,前列腺腺癌的Gleason评分进展课件,14,前列腺腺癌的Gleason评分进展课件,15,前列腺腺癌的Gleason评分进展课件,16,前列腺腺癌的Gleason评分进展课件,17,前列腺腺癌的Gleason评分进展课件,18,前列腺腺癌的Gleason评分进展课件,19,前列腺腺癌的Gleason评分进展课件,20,前列腺腺癌的Gleason评分进展课件,21,前列腺腺癌的Gleason评分进展课件,22,前列腺腺癌的Gleason评分进展课件,23,前列腺腺癌的Gleason评分进展课件,24,前列腺腺癌的Gleason评分进展课件,25,前列腺腺癌的Gleason评分进展课件,26,前列腺腺癌的Gleason评分进展课件,27,前列腺腺癌的Gleason评分进展课件,28,前列腺腺癌的Gleason评分进展课件,29,前列腺腺癌的Gleason评分进展课件,30,前列腺腺癌的Gleason评分进展课件,31,前列腺腺癌的Gleason评分进展课件,32,前列腺腺癌的Gleason评分进展课件,33,前列腺腺癌的Gleason评分进展课件,34,前列腺腺癌的Gleason评分进展课件,35,