Long term evaluation of optimized Gleason grading in a large cohort of men with prostate cancer in Canada

IF 2.7 2区医学 Q2 PATHOLOGY

Human pathology Pub Date : 2024-04-01 DOI:10.1016/j.humpath.2024.04.002

Michel Wissing MD, PhD (researcher) , Fadi Brimo MD (associate professor) , Ginette McKercher MSc (researcher) , Eleonora Scarlata DVM, PhD (researcher) , Fred Saad MD (professor) , Michel Carmel MD (professor) , Louis Lacombe MD (professor) , Bernard Têtu MD (professor) , Nadia Ekindi-Ndongo MD (assistant professor) , Mathieu Latour MD (clinical associate professors) , Dominique Trudel MD, PhD (clinical associate professors) , Simone Chevalier PhD (professor) , Armen Aprikian MD (professor)

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引用次数: 0

Abstract

Objectives

To evaluate the International Society of Urological Pathology (ISUP) 5-tier grade grouping (GG) system of prostate cancers as well as previously proposed optimizations.

Patients and methods

The PROCURE biobank is a prospective cohort study of patients with localized prostate cancer who underwent radical prostatectomy in Quebec province between 2005 and 2013. Surgical specimens were graded by experienced genitourinary pathologists using 2019 ISUP criteria. Follow-up was conducted until November 2021. The current 5-tier and a proposed 6-tier GG system were evaluated, the latter having two changes: 1) Gleason 3 + 4 and 4 + 3 tumors with minor/tertiary Gleason 5 patterns were upgraded to GG 3 and 4, respectively; and 2) patients in GG5 were separated based on primary Gleason pattern (4 or 5). Cox proportional hazards models and Harrell's concordance (C) indices were used for statistical analyses.

Results

2003 patients were included (median follow-up: 8.7 years). The current 5-tier GG system predicted time to recurrence (hazard ratio [HR] 2.12, 95% confidence interval [95%CI] 1.99–2.25, C 0.717), androgen-deprivation therapy (HR 2.58, 95%CI 2.38–2.80, C 0.790), metastasis (HR 2.48, 95%CI 2.17–2.83, C 0.806), castration-resistant prostate cancer (HR 2.67, 95%CI 2.28–3.13, C 0.829), and cancer-specific mortality (HR 2.80, 95%CI 2.27–3.44, C 0.835). Goodness-of-fit further improved with the proposed 6-tier GG system, with Harrell's C of 0.733, 0.807, 0.827, 0.853, and 0.853, respectively.

Conclusions

The 5-tier GG system predicted short- and long-term outcomes for patients with localized prostate cancer, and the proposed 6-tier GG system further improved its accuracy.

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对加拿大一大批前列腺癌男性患者进行优化格里森分级的长期评估

目的评估国际泌尿病理学会（ISUP）前列腺癌 5 级分级分组（GG）系统以及之前提出的优化方案。患者和方法PROCURE 生物库是一项前瞻性队列研究，研究对象是 2005 年至 2013 年期间在魁北克省接受根治性前列腺切除术的局部前列腺癌患者。手术标本由经验丰富的泌尿生殖病理学家根据 2019 ISUP 标准进行分级。随访至 2021 年 11 月。对现行的 5 级 GG 系统和拟议的 6 级 GG 系统进行了评估，后者有两个变化：1）Gleason 3 + 4 和 4 + 3 肿瘤的轻微/三级 Gleason 5 模式分别升级为 GG 3 和 4；2）GG5 患者根据原发 Gleason 模式（4 或 5）进行区分。统计分析采用 Cox 比例危险模型和 Harrell 一致度（C）指数。目前的 5 级 GG 系统可预测复发时间（危险比 [HR] 2.12，95% 置信区间 [95%CI] 1.99-2.25，C 0.717）、雄激素剥夺治疗（HR 2.58，95%CI 2.38-2.80，C 0.790）、转移（HR 2.48，95%CI 2.17-2.83，C 0.806）、阉割抵抗性前列腺癌（HR 2.67，95%CI 2.28-3.13，C 0.829）和癌症特异性死亡率（HR 2.80，95%CI 2.27-3.44，C 0.835）。结论5级GG系统可预测局部前列腺癌患者的短期和长期预后，而拟议的6级GG系统进一步提高了其准确性。

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来源期刊

Human pathology 医学-病理学

CiteScore

5.30

自引率

6.10%

发文量

206

审稿时长

21 days

期刊介绍： Human Pathology is designed to bring information of clinicopathologic significance to human disease to the laboratory and clinical physician. It presents information drawn from morphologic and clinical laboratory studies with direct relevance to the understanding of human diseases. Papers published concern morphologic and clinicopathologic observations, reviews of diseases, analyses of problems in pathology, significant collections of case material and advances in concepts or techniques of value in the analysis and diagnosis of disease. Theoretical and experimental pathology and molecular biology pertinent to human disease are included. This critical journal is well illustrated with exceptional reproductions of photomicrographs and microscopic anatomy.