摘要：Gleason评分对于前列腺癌风险评估、治疗决策制定和预后判断有重要价值，而前列腺穿刺活检与根治性 前列腺切除术 （radical prostatectomy，RP） 后病理的 Gleason 评分常存在差异，且主要表现为评分升级，这 严重影响了临床决策的制定及预后判断。本文回顾近年国内外相关文献，对RP后Gleason评分升级相关因素的研 究进展作一综述，旨在为患者提供更加精准的风险评估和最佳的个体化治疗方案，最终改善患者预后，提高生存质量。

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GLOBOCAN 2020 数据显示，全球前列腺癌 （prostate cancer，PCa） 患病率居男性恶性肿瘤第 2 位，病死率居第 5位[1] 。与欧美发达地区相比，我国 前列腺癌患病率较低，但近年呈显著上升趋势。前 列腺穿刺活检是目前唯一能够获取前列腺癌确诊信 息的临床检测手段[2] ，穿刺病理提供的 Gleason 评分 对于疾病风险评估、治疗决策制定和判断预后有着 重要的意义。由于病理分级错误、肿瘤异质性或抽 样误差等原因，临床中前列腺穿刺活检与根治性前 列腺切除术后病理的 Gleason评分常存在差异，且主 要表现为评分升级。这不仅影响了诊治策略的选择， 且 Gleason 评分升级与根治性前列腺切除术 （radical prostatectomy，RP） 后手术切缘阳性、包膜外 或精囊侵犯、生化复发等不良预后相关[3] 。本文回顾 近年国内外相关文献，对根治性前列腺切除术后 Gleason评分升级相关因素的研究进展作一综述。

1 年龄、体质量指数 （body mass index，BMI） 对 Gleason 评分升级的影响

2 临床指标对 Gleason 评分升级的影响
    2.1 前列腺特异性抗原
    2.2 炎性细胞

3 穿刺相关因素对 Gleason 评分升级的影响
    3.1 穿刺方式、穿刺至 RP 间隔时间
    3.2 穿刺针数、穿刺阳性针数及穿刺阳性针数百分 比、肿瘤组织长度 （肿瘤百分比）、穿刺长度

4 前列腺影像报告和数据系统 （prostate imaging reporting and data system，PI-RADS） 对 Gleason 评分升级的影响

5 其他因素及预测模型建立

6 小结

6 小结 

影响前列腺穿刺活检与 RP 后 Gleason评分升级 的因素众多，部分因素尚存在争议，各因素间可能 存在交互作用，一些潜在的可能有意义的因素尚未 被纳入研究，未来更多的大规模、多中心前瞻性研 究有望进一步阐明影响 Gleason 评分升级的预测因 素。临床上结合多项预测因素进行综合评估，能够 增加泌尿科医生在临床决策方面的信心，为前列腺 癌患者提供更加精确全面的风险评估及最佳的个体 化治疗方案，最终改善患者预后，提高生存质量。

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