Rusthoven Chad G, Carlson Julie A, Waxweiler Timothy V, Yeh Norman, Raben David, Flaig Thomas W, Kavanagh Brian D
Department of Radiation Oncology, University of Colorado-Denver, Aurora, CO.
Department of Radiation Oncology, University of Colorado-Denver, Aurora, CO.
Urol Oncol. 2014 Jul;32(5):707-13. doi: 10.1016/j.urolonc.2014.01.004. Epub 2014 Mar 12.
Although the majority of metastatic prostate cancer (mPCa) will arise from tumors with Gleason scores (GS) of 8 to 10 existing tumor grade analyses for mPCa have been almost uniformly limited to comparisons of ≤7 vs. ≥8. In this analysis, we comprehensively evaluate the GS as a prognostic factor for mPCa in the era of the updated Gleason grading system.
The Surveillance, Epidemiology, and End Results (SEER) database was queried for patients with mPCa, GS 6 to 10, diagnosed from 2006 to 2008. GS and primary-secondary Gleason pattern variations were analyzed for overall survival and prostate cancer-specific survival (PCSS).
A total of 4,654 patients were evaluable. At 4 years, the overall survival rates were 51%, 45%, 34%, 25%, and 15% and PCSS rates were 69%, 57%, 44%, 33%, and 21% for GS 6, 7, 8, 9, and 10, respectively. Survival differences for GS 7 vs. 8, 8 vs. 9, and 9 vs. 10 were highly significant on both univariate and multivariate analyses accounting for age, prostate-specific antigen level, and T stage (all P<0.001). Gleason pattern 5 was an independent prognostic factor, both overall for patients with GS 6 to 10 and on primary-secondary Gleason pattern comparisons within the GS 8 (4+4 vs. 3+5 and 5+3) and GS 9 (4+5 vs. 5+4) subgroups. No survival differences were observed between 3+4 vs. 4+3. Overall, lower prostate-specific antigen level, younger age, and lower GS were associated with improved survival, with GS being the strongest prognostic factor for PCSS.
In this large population-based cohort, stratified survival outcomes were observed for GS 6 to 10, with sequential comparisons of GS 7 to 10, and the presence and extent of Gleason pattern 5 representing independent prognostic factors in the metastatic setting.
尽管大多数转移性前列腺癌（mPCa）起源于 Gleason 评分（GS）为 8 至 10 的肿瘤，但现有的 mPCa 肿瘤分级分析几乎都局限于比较 GS≤7 与 GS≥8 的情况。在本分析中，我们在更新的 Gleason 分级系统时代全面评估 GS 作为 mPCa 的预后因素。
查询监测、流行病学和最终结果（SEER）数据库，获取 2006 年至 2008 年诊断为 mPCa、GS 为 6 至 10 的患者。分析 GS 以及主要-次要 Gleason 模式变化对总生存期和前列腺癌特异性生存期（PCSS）的影响。
共有 4654 例患者可进行评估。4 年时，GS 为 6、7、8、9 和 10 的患者总生存率分别为 51%、45%、34%、25%和 15%，PCSS 率分别为 69%、57%、44%、33%和 21%。在对年龄、前列腺特异性抗原水平和 T 分期进行单因素和多因素分析时，GS 7 与 8、8 与 9、9 与 10 之间的生存差异均高度显著（所有 P<0.001）。Gleason 模式 5 是一个独立的预后因素，对于 GS 为 6 至 10 的患者总体如此，在 GS 8（4+4 与 3+5 和 5+3）和 GS 9（4+5 与 5+4）亚组内的主要-次要 Gleason 模式比较中也是如此。3+4 与 4+3 之间未观察到生存差异。总体而言，较低的前列腺特异性抗原水平、较年轻的年龄和较低的 GS 与生存改善相关，GS 是 PCSS 的最强预后因素。
在这个基于人群的大型队列中，观察到 GS 为 6 至 10 的分层生存结果，GS 7 至 10 依次比较，且 Gleason 模式 5 的存在和范围在转移情况下代表独立的预后因素。
