【前立腺】前立腺癌診断・報告UP-DATE要点2019

Essential Updates in Grading, Morphotyping, Reporting, and Staging of Prostate Carcinoma for General Surgical Pathologists

Gladell P. Paner, MD; Jatin Gandhi, MD; Bonnie Choy, MD; Mahul B. Amin, MD
Arch Pathol Lab Med (2019) 143 (5): 550–564.

これは前立腺癌の診断に携わる病理医は是非一読すべき内容である。前立腺癌の診断、特に Gleason Grading System の運用に関して、個人的に国内での診断一致が十分得られていないと感じる一方で、胃の「腺腫か粘膜内癌」かのような一致しなくても臨床上あまり問題ない事項と異なり、Grading が直に治療方針に関わってくるのである。しかも、Gleason pattern 4 の割合も重要視されるので、pattern 3 と pattern 4 の区別は非常に難しいが、極めて重要になっている。特にこの点に関して、最新の WHO 分類とあわせて、本論文の内容を十二分に熟読・把握すべきと考える。なお、本論文はフリーダウンロード可なので、下記リンクから是非みていただきたい。

Abstract
Context: Within this decade, several important updates in prostate cancer have been presented through expert international consensus conferences and influential publications of tumor classification and staging.
Objective: To present key updates in prostate carcinoma.
Data sources: The study comprised a review of literature and our experience from routine and consultation practices.
Conclusions: Grade groups, a compression of the Gleason system into clinically meaningful groups relevant in this era of active surveillance and multidisciplinary care management for prostate cancer, have been introduced. Refinements in the Gleason patterns notably result in the contemporarily defined Gleason score 6 cancers having a virtually indolent behavior. Grading of tertiary and minor higher-grade patterns in radical prostatectomy has been clarified. A new classification for prostatic neuroendocrine tumors has been promulgated, and intraductal, microcystic, and pleomorphic giant cell carcinomas have been officially recognized. Reporting the percentage of Gleason pattern 4 in Gleason score 7 cancers has been recommended, and data on the enhanced risk for worse prognosis of cribriform pattern are emerging. In reporting biopsies for active surveillance criteria-based protocols, we outline approaches in special situations, including variances in sampling or submission. The 8th American Joint Commission on Cancer TNM staging for prostate cancer has eliminated pT2 subcategorization and stresses the importance of nonanatomic factors in stage groupings and outcome prediction. As the clinical and pathology practices for prostate cancer continue to evolve, it is of utmost importance that surgical pathologists become fully aware of the new changes and challenges that impact their evaluation of prostatic specimens.

【SANOTIC SUMMARY】
大事な点はたくさんあり、pT2 の亜分類がなくなったことも大きいようで些末な気もして、個人的に特に重要と思う点を３点のみ抜粋する。できれば全文をきちんと読んでいただきたいと思う。

１．GS 7 (3+4, 4+3) が最も予後が多彩な群
👉GP 4 の割合は予後と相関するので記載すべし

２．GP 3 は厳密化された：GP 3 と 4 の鑑別点を把握すべし
👉腺管の大きさに関わらず well-formed gland は GP 3（萎縮様の小型腺管、過形成様の大型腺管を含む）
👉切れ方で説明できるものは GP 3 の範疇（GP 4 とするには 5 腺管以上のクラスターが必要）

３． 切除断端の陽性範囲が重要：3 mm 以上 or 3 mm 未満
👉断端陽性部の GP も optional だが重要

フリーダウンロードはこちらから👇

Essential Updates in Grading, Morphotyping, Reporting, and Staging of Prostate Carcinoma for General Surgical Pathologists | Archives of Pathology & Laboratory Medicine | Allen Press

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