Kang David E, Fitzsimons Nicholas J, Presti Joseph C, Kane Christopher J, Terris Martha K, Aronson William J, Amling Christopher L, Freedland Stephen J
Division of Urologic Surgery, Department of Surgery and Duke Prostate Center, Duke University School of Medicine, Durham, North Carolina, USA.
Urology. 2007 Aug;70(2):277-82. doi: 10.1016/j.urology.2007.03.059.
Gleason score 4+3 prostate cancer is associated with worse clinicopathologic outcomes than is Gleason score 3+4. Whether the increased risk associated with Gleason score 4+3 disease is equivalent to that of Gleason score 4+4 or greater is unclear.
We reviewed the data from two separate cohorts pulled from the Shared Equal Access Regional Cancer Hospital database. The first consisted of 374 men with biopsy Gleason score 3+4 or greater disease and the second of 636 men with radical prostatectomy (RP) Gleason score 3+4 or greater disease. We estimated the odds ratios of unfavorable surgical pathologic findings for the biopsy Gleason score categories using logistic regression analysis. Using a Cox proportional hazards regression model, we estimated the relative risk of biochemical progression associated with each biopsy and RP Gleason score category.
In the biopsy Gleason score cohort, a Gleason score of 4+3 was associated with an increased risk of extracapsular extension (P = 0.01) and seminal vesicle invasion (P <0.001) relative to a biopsy Gleason score of 3+4. A biopsy Gleason score of 4+3 was associated with a similar risk of adverse pathologic findings relative to a biopsy Gleason score of 4+4 or greater (all P >0.10), except for higher grade pathologic tumors among men with a biopsy Gleason score of 4+4 or more (P = 0.001). After adjusting for multiple clinical characteristics, a biopsy Gleason score of 4+3 was associated with an increased recurrence risk relative to a biopsy Gleason score of 3+4 (P = 0.001), but a similar progression risk as that for a biopsy Gleason score of 4+4 or more (P = 0.53). In the RP Gleason cohort, and after adjustment for multiple clinicopathologic features, an RP Gleason score of 4+3 was associated with increased progression risk relative to an RP Gleason score of 3+4 (P = 0.03), but similar progression risk as that for an RP Gleason score of 4+4 or more (P = 0.24).
In a multicenter database using pooled data from multiple pathologists, Gleason scores 4+3 and 4+4 or more exhibited similar clinicopathologic outcomes.
与Gleason评分3 + 4相比，Gleason评分4 + 3的前列腺癌具有更差的临床病理结局。目前尚不清楚与Gleason评分4 + 3疾病相关的风险增加是否等同于Gleason评分4 + 4或更高的情况。
我们回顾了从共享平等访问区域癌症医院数据库中提取的两个独立队列的数据。第一个队列由374例活检Gleason评分3 + 4或更高的男性组成，第二个队列由636例根治性前列腺切除术（RP）Gleason评分3 + 4或更高的男性组成。我们使用逻辑回归分析估计活检Gleason评分类别中不良手术病理结果的比值比。使用Cox比例风险回归模型，我们估计了与每个活检和RP Gleason评分类别相关的生化进展的相对风险。
在活检Gleason评分队列中，与活检Gleason评分3 + 4相比，Gleason评分4 + 3与包膜外扩展风险增加（P = 0.01）和精囊侵犯风险增加（P <0.001）相关。与活检Gleason评分4 + 4或更高相比，活检Gleason评分4 + 3与不良病理结果的风险相似（所有P>0.10），除了活检Gleason评分4 + 4或更高的男性中高级别病理肿瘤更多（P = 0.001）。在调整多个临床特征后，与活检Gleason评分3 + 4相比，活检Gleason评分4 + 3与复发风险增加相关（P = 0.001），但与活检Gleason评分4 + 4或更高的进展风险相似（P = 0.53）。在RP Gleason队列中，在调整多个临床病理特征后，与RP Gleason评分3 + 4相比，RP Gleason评分4 + 3与进展风险增加相关（P = 0.03），但与RP Gleason评分4 + 4或更高的进展风险相似（P = 0.24）。
在使用来自多个病理学家汇总数据的多中心数据库中，Gleason评分4 + 3和4 + 4或更高显示出相似的临床病理结局。
