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Prior studies assessing the correlation of Gleason score (GS) at needle biopsy and corresponding radical prostatectomy (RP) predated the use of the modified Gleason scoring system and did not factor in tertiary grade patterns.
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Several studies have investigated the clinical significance of a tertiary grade in radical prostatectomy samples.
However, modification of the Gleason score to include a tertiary grade in Gleason 4+3 tumours might overestimate the risk of seminal-vesicle or lymph-node invasion.
In the small number of studies available, the frequency of a tertiary grade was consistently higher in samples characterised with pathological variables of poor outcome, such as extra-prostatic extension and positive surgical margins, but not lymph-node metastases.
In five studies the presence of a tertiary grade increased the risk of prostate-specific antigen recurrence after radical prostatectomy by a factor of 2·5.
A tertiary grade should, therefore, be included in the pathological reporting of prostate cancer and be considered in the interpretation and design of clinical trials.
This systematic review has established the association of a tertiary grade with poorer outcome than that associated with no tertiary grade.
The mean score of each domain of tertiary grade A hospitals was higher than that of tertiary grade B separately, and statistical difference was confirmed among most domains.
Indigenous women were over-represented in the lower education categories and under-represented in tertiary education: ≤ Grade 10 (21.9% difference, 95% CI 19.2, 24.6%); Grade 11 and 12 (1.8% difference, 95% CI −0.8, 4.4%) and tertiary education (20.0% difference, 95% CI −21.8, -18.2%).
The handling of tertiary grades is of practical importance only with respect to grade 7 cancers.
Lung function tests are largely available in tertiary hospitals (in particular, the grade-A tertiary hospitals) throughout China, where spirometry is fully accessible.
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