Deng Fang-Ming, Donin Nicholas M, Pe Benito Ruth, Melamed Jonathan, Le Nobin Julien, Zhou Ming, Ma Sisi, Wang Jinhua, Lepor Herbert
Department of Pathology, New York University School of Medicine, New York, NY, USA.
Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Eur Urol. 2016 Aug;70(2):248-53. doi: 10.1016/j.eururo.2015.10.026. Epub 2015 Oct 30.
The risk of biochemical recurrence (BCR) following radical prostatectomy for pathologic Gleason 7 prostate cancer varies according to the proportion of Gleason 4 component.
We sought to explore the value of several novel quantitative metrics of Gleason 4 disease for the prediction of BCR in men with Gleason 7 disease.
DESIGN, SETTING, AND PARTICIPANTS: We analyzed a cohort of 2630 radical prostatectomy cases from 1990-2007. All pathologic Gleason 7 cases were identified and assessed for quantity of Gleason pattern 4. Three methods were used to quantify the extent of Gleason 4: a quantitative Gleason score (qGS) based on the proportion of tumor composed of Gleason pattern 4, a size-weighted score (swGS) incorporating the overall quantity of Gleason 4, and a size index (siGS) incorporating the quantity of Gleason 4 based on the index lesion.
Associations between the above metrics and BCR were evaluated using Cox proportional hazards regression analysis.
qGS, swGS, and siGS were significantly associated with BCR on multivariate analysis when adjusted for traditional Gleason score, age, prostate specific antigen, surgical margin, and stage. Using Harrell's c-index to compare the scoring systems, qGS (0.83), swGS (0.84), and siGS (0.84) all performed better than the traditional Gleason score (0.82).
Quantitative measures of Gleason pattern 4 predict BCR better than the traditional Gleason score.
In men with Gleason 7 prostate cancer, quantitative analysis of the proportion of Gleason pattern 4 (quantitative Gleason score), as well as size-weighted measurement of Gleason 4 (size-weighted Gleason score), and a size-weighted measurement of Gleason 4 based on the largest tumor nodule significantly improve the predicted risk of biochemical recurrence compared with the traditional Gleason score.
病理Gleason 7级前列腺癌根治性前列腺切除术后生化复发（BCR）的风险因Gleason 4级成分的比例而异。
我们试图探讨几种新的Gleason 4级疾病定量指标对预测Gleason 7级疾病男性BCR的价值。
设计、设置和参与者：我们分析了1990年至2007年的2630例根治性前列腺切除术病例队列。识别所有病理Gleason 7级病例，并评估Gleason 4级模式的数量。使用三种方法量化Gleason 4级的范围：基于Gleason 4级肿瘤比例的定量Gleason评分（qGS）、纳入Gleason 4级总量的大小加权评分（swGS）以及基于索引病灶纳入Gleason 4级数量的大小指数（siGS）。
使用Cox比例风险回归分析评估上述指标与BCR之间的关联。
在对传统Gleason评分、年龄、前列腺特异性抗原、手术切缘和分期进行调整后的多变量分析中，qGS、swGS和siGS与BCR显著相关。使用Harrell c指数比较评分系统，qGS（0.83）、swGS（0.84）和siGS（0.84）均比传统Gleason评分（0.82）表现更好。
Gleason 4级的定量测量比传统Gleason评分能更好地预测BCR。
在Gleason 7级前列腺癌男性中，与传统Gleason评分相比，对Gleason 4级比例的定量分析（定量Gleason评分）、Gleason 4级的大小加权测量（大小加权Gleason评分）以及基于最大肿瘤结节的Gleason 4级大小加权测量显著提高了生化复发的预测风险。
