Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Int J Urol. 2013 Sep;20(9):880-8. doi: 10.1111/iju.12064. Epub 2013 Jan 24.
In the TNM seventh edition, a prognostic grouping for prostate cancer incorporating prostate-specific antigen and Gleason score was advocated. The present study was carried out to evaluate and validate prognostic grouping in prostate cancer patients.
The 15 259 study patients treated with primary androgen deprivation therapy were enrolled in the Japan Study Group of Prostate Cancer. Overall survival was stratified by tumor-nodes-metastasis, Gleason score and prostate-specific antigen, and extensively analyzed. The accuracy of grouping systems was evaluated by the concordance index.
The 5-year overall survival in prognostic grouping-I, IIA, IIB, III and IV was 90.0%, 88.3%, 84.8%, 80.6% and 57.1%, respectively. When considering subgroup stratification, the 5-year overall survival of subgroups prognostic grouping-IIA, IIB, III and IV was 80.9∼90.5%, 75.4∼91.8%, 75.7∼89.0% and 46.9∼86.2%, respectively. When prognostic grouping-IIB was subclassified into IIB1 (except IIB2) and IIB2 (T1-2b, prostate-specific antigen >20, Gleason score ≥8, and T2c, Gleason score ≥8), the 5-year overall survival of IIB2 was significantly lower than that of IIB1 (79.4% and 87.3%, P < 0.0001). Also, when prognostic grouping-IV was subclassified into IV1 (except IV2) and IV2 (M1, prostate-specific antigen >100 or Gleason score ≥8), the 5-year overall survival of prognostic grouping-IV1 was superior to that of IV2 (72.9% and 49.5%, P < 0.0001). Prognostic groupings were reclassified into modified prognostic groupings, divided into modified prognostic grouping-A (prognostic grouping-I, IIA, and IIB1), modified prognostic grouping-B (prognostic grouping-IIB2 and III), modified prognostic grouping-C (prognostic grouping-IV1) and modified prognostic grouping-D (prognostic grouping-IV2). The concordance index of prognostic grouping and modified prognostic grouping for overall survival was 0.670 and 0.685, respectively.
Prognostic grouping could stratify the prognosis of prostate cancer patients. However, there is considerable variation among the prognostic grouping subgroups. Thus, the use of a modified prognostic grouping for patients treated with primary androgen deprivation therapy is advisable.
在第七版 TNM 中，提出了一种包含前列腺特异性抗原和 Gleason 评分的前列腺癌预后分组。本研究旨在评估和验证前列腺癌患者的预后分组。
本研究纳入了接受原发雄激素剥夺治疗的 15259 例患者。采用肿瘤-淋巴结-转移（TNM）、Gleason 评分和前列腺特异性抗原对总生存进行分层，并进行了广泛分析。采用一致性指数评估分组系统的准确性。
预后分组 I、IIA、IIB、III 和 IV 的 5 年总生存率分别为 90.0%、88.3%、84.8%、80.6%和 57.1%。考虑亚组分层后，预后分组 IIA、IIB、III 和 IV 的 5 年总生存率分别为 80.9%～90.5%、75.4%～91.8%、75.7%～89.0%和 46.9%～86.2%。当将预后分组 IIB 细分为 IIB1（不包括 IIB2）和 IIB2（T1-2b、前列腺特异性抗原>20、Gleason 评分≥8、T2c、Gleason 评分≥8）时，IIB2 的 5 年总生存率明显低于 IIB1（79.4%和 87.3%，P<0.0001）。此外，当将预后分组 IV 细分为 IV1（不包括 IV2）和 IV2（M1、前列腺特异性抗原>100 或 Gleason 评分≥8）时，IV1 的 5 年总生存率优于 IV2（72.9%和 49.5%，P<0.0001）。将预后分组重新分类为改良预后分组，分为改良预后分组 A（预后分组 I、IIA 和 IIB1）、改良预后分组 B（预后分组 IIB2 和 III）、改良预后分组 C（预后分组 IV1）和改良预后分组 D（预后分组 IV2）。预后分组和改良预后分组对总生存率的一致性指数分别为 0.670 和 0.685。
预后分组可对前列腺癌患者的预后进行分层。然而，各预后分组亚组之间存在相当大的差异。因此，对于接受原发雄激素剥夺治疗的患者，使用改良预后分组是明智的。
