前列腺腺癌的Gleason评分进展课件

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(Newprognosticgradingsystem)WHOCIasefieatianatWHOclassificationofTumouroftheUrinarySystemandMaleGenitalOrgans(2016Gleason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Gleaso1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(Newprognosticgradingsystem)WHOCIasefieatianatWHOclassificationofTumouroftheUrinarySystemandMaleGenitalOrgans(2016纲要2Gleason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3Gleasongradingsystem(Gleason分级系统)ThemostwidelyusedgradingsystemforprostaticadenocarcinomaDevelopedin1966byDrDonaldGleasonBasedongeneralhistologicappearance(notmitoticcountorcelltypes)5patterns(patter1topattern5)(Gleasongrade1to5:5)Furtherrefinedin1974,1977,1992,2005,2014Gleasongradingsystem(Gleaso4Gas0n分级量新进展2015修订版08的楼WenwenIYouaMedia02015IdaaUnlGas0n分级量新进展5Gleason分级最新进展1对特殊组织学形态的共ISUP2005ISUP2014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Gleason4(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3Gleason分级最新进展16Gleason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Gleason4Gleason3,看腺体结构而定Gleason分级最新进展17Geas0n分级最新进展2新增导管内癌(IDCP)Intraductalcarcinomaofprostate:IDC-P1985年首先由Ko提出目前最常用的诊断标准:2006年GuoandEpstein提出诊断标准Malignantepithelialcellsfillinglargeaciniandprostaticducts,withpreservationofbasalcellsandeitherasolidordensecribriformpatternoraloosecribriformormicropapillarypatternwitheithermarkednuclearatypia(nuclearsize6xnormal)orcomedonecrosisGeas0n分级最新进展28Geas0n分级最新进展2粉刺状|DCP实体型DCP筛状型[DCGeas0n分级最新进展29Geas0n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210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