Aktuelle Urol 2019; 50(06): 619-624
DOI: 10.1055/a-0918-9473
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Das neue ISUP 2014/WHO 2016 Prostatakarzinom-Grading – Status quo 5 Jahre nach seiner Einführung

Status quo 5 years after the introduction of the new ISUP 2014/WHO 2016 prostate cancer grade groups
Marie Christine Hupe
1   Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Urologie, Lübeck
,
Anne Offermann
2   Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Institut für Pathologie
3   Forschungszentrum Borstel, Leibniz Lungenzentrum, Institut für Pathologie
,
Verena Sailer
2   Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Institut für Pathologie
3   Forschungszentrum Borstel, Leibniz Lungenzentrum, Institut für Pathologie
,
Axel S. Merseburger
1   Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Klinik für Urologie, Lübeck
,
Sven Perner
2   Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Institut für Pathologie
3   Forschungszentrum Borstel, Leibniz Lungenzentrum, Institut für Pathologie
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
07. August 2019 (online)

Zusammenfassung

Hintergrund Im Jahr 2014 wurde durch die ISUP (International Society of Urological Pathology) eine Modifikation des Gradings für das Prostatakarzinom (PCa) eingeführt, welches 2016 von der Weltgesundheitsorganisation (WHO) anerkannt und übernommen wurde. Neben der Definition von 5 „Grade Groups“ wurden auch einige histomorphologische Kriterien angepasst. Unsere Übersichtsarbeit stellt die Ergebnisse aller aktuellen Studien und deren Bewertungen des neuen Gradings zusammen.

Material und Methoden Es erfolgte eine Literaturrecherche in der PubMed-Datenbank. Insgesamt sind aus dem Zeitraum 2016 – 2018 15 Studien identifiziert und in die Übersicht eingeschlossen worden.

Ergebnisse Die Hauptziele des neuen ISUP 2014/WHO 2016 PCa-Gradings sind ein (I) präziseres und vereinfachtes Grading, (II) eine verringerte Übertherapie indolenter PCa und (III) eine verbesserte Kommunikation mit den Patienten. Die Mehrzahl der Studien wählte das biochemische Rezidiv als Endpunkt und bescheinigte dem neuen Grading eine höhere prognostische Wertigkeit im Vergleich zum früheren Gleason Grading. Interessanterweise war es jedoch nur in wenigen Studien klar ersichtlich, dass die archivierten Proben tatsächlich auch nach den modifizierten histomorphologischen Kriterien reevaluiert („Re-Grading“) und nicht nur in die neuen „Grade Groups“ übersetzt wurden („Re-Grouping“).

Schlussfolgerung Die Mehrheit der analysierten Studien bestätigt die prognostische Wertigkeit des neuen ISUP 2014/WHO 2016 Gradings und empfiehlt dessen weltweite Anwendung. Jedoch muss bei der Interpretation bisheriger Studien berücksichtigt werden, dass das notwendige „Re-Grading“ als korrekte Anwendung des neuen Gradings nicht immer klar ersichtlich war.

Abstract

Background In 2014, the International Society of Urological Pathology (ISUP) introduced a new grading system for prostate cancer (PCa), which was accepted and adopted by the World Health Organisation (WHO) in 2016. The new system defined five distinct grade groups and adjusted several histomorphological criteria. Our study aimed to systematically review and summarise the most recent literature and to compare the new grading system with the former Gleason grading.

Material and Methods We performed a literature screening in the PubMed database. A total of 15 studies evaluating the new grading system during the period from 2016 to 2018 were selected for our review.

Results The main goals of the new ISUP 2014/WHO 2016 grading system were a more accurate and simplified grade stratification, less overtreatment of indolent PCa as well as improved patient communication. Biochemical recurrence was the most common endpoint for statistical analysis. Most studies found that the new ISUP 2014/WHO 2016 grading system provides higher prognostic accuracy than the former Gleason grading. Notably, however, only a subset of studies clearly demonstrated that the archived samples were not only re-grouped according to the new grade groups, but also re-graded according to the new histomorphological 2014 ISUP criteria.

Conclusions The prognostic accuracy of the ISUP 2014/WHO 2016 grade groups was confirmed by the majority of the studies. Nevertheless, the interpretation of the study results should be based upon the criterion of correct re-grading.

 
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