{"title":"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","authors":"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)","doi":"10.1016/j.humpath.2024.04.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><p>To evaluate the International Society of Urological Pathology (ISUP) 5-tier grade grouping (GG) system of prostate cancers as well as previously proposed optimizations.</p></div><div><h3>Patients and methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":13062,"journal":{"name":"Human pathology","volume":null,"pages":null},"PeriodicalIF":2.7000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0046817724000546/pdfft?md5=bfdabb3275dfa9494c9b239cffd118e2&pid=1-s2.0-S0046817724000546-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Long term evaluation of optimized Gleason grading in a large cohort of men with prostate cancer in Canada\",\"authors\":\"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)\",\"doi\":\"10.1016/j.humpath.2024.04.002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><p>To evaluate the International Society of Urological Pathology (ISUP) 5-tier grade grouping (GG) system of prostate cancers as well as previously proposed optimizations.</p></div><div><h3>Patients and methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>\",\"PeriodicalId\":13062,\"journal\":{\"name\":\"Human pathology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S0046817724000546/pdfft?md5=bfdabb3275dfa9494c9b239cffd118e2&pid=1-s2.0-S0046817724000546-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Human pathology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0046817724000546\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PATHOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Human pathology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0046817724000546","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PATHOLOGY","Score":null,"Total":0}
Long term evaluation of optimized Gleason grading in a large cohort of men with prostate cancer in Canada
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.
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.