Spratt Daniel E, Cole Adam I, Palapattu Ganesh S, Weizer Alon Z, Jackson William C, Montgomery Jeffrey S, Dess Robert T, Zhao Shuang G, Lee Jae Y, Wu Angela, Kunju Lakshmi P, Talmich Emily, Miller David C, Hollenbeck Brent K, Tomlins Scott A, Feng Felix Y, Mehra Rohit, Morgan Todd M
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Department of Urology, University of Michigan, Ann Arbor, MI, USA.
BJU Int. 2016 Nov;118(5):763-769. doi: 10.1111/bju.13488. Epub 2016 Apr 19.
To report the independent prognostic impact of the new prostate cancer grade-grouping system in a large external validation cohort of patients treated with radical prostatectomy (RP).
Between 1994 and 2013, 3 694 consecutive men were treated with RP at a single institution. To investigate the performance of and validate the grade-grouping system, biochemical recurrence-free survival (bRFS) rates were assessed using Kaplan-Meier tests, Cox-regression modelling, and discriminatory comparison analyses. Separate analyses were performed based on biopsy and RP grade.
The median follow-up was 52.7 months. The 5-year actuarial bRFS for biopsy grade groups 1-5 were 94.2%, 89.2%, 73.1%, 63.1%, and 54.7%, respectively (P < 0.001). Similarly, the 5-year actuarial bRFS based on RP grade groups was 96.1%, 93.0%, 74.0%, 64.4%, and 49.9% for grade groups 1-5, respectively (P < 0.001). The adjusted hazard ratios for bRFS relative to biopsy grade group 1 were 1.98, 4.20, 5.57, and 9.32 for groups 2, 3, 4, and 5, respectively (P < 0.001), and for RP grade groups were 2.09, 5.27, 5.86, and 10.42 (P < 0.001). The five-grade-group system had a higher prognostic discrimination compared with the commonly used three-tier system (Gleason score 6 vs 7 vs 8-10).
In an independent surgical cohort, we have validated the prognostic benefit of the new prostate cancer grade-grouping system for bRFS, and shown that the benefit is maintained after adjusting for important clinicopathological variables. The greater predictive accuracy of the new system will improve risk stratification in the clinical setting and aid in patient counselling.
在接受根治性前列腺切除术（RP）治疗的大型外部验证队列中，报告新的前列腺癌分级分组系统的独立预后影响。
1994年至2013年期间，一家机构连续3694名男性接受了RP治疗。为研究分级分组系统的性能并进行验证，使用Kaplan-Meier检验、Cox回归模型和鉴别比较分析评估无生化复发生存率（bRFS）。根据活检和RP分级进行了单独分析。
中位随访时间为52.7个月。活检1-5级组的5年精算bRFS分别为94.2%、89.2%、73.1%、63.1%和54.7%（P<0.001）。同样，基于RP分级组的5年精算bRFS，1-5级组分别为96.1%、93.0%、74.0%、64.4%和49.9%（P<0.001）。相对于活检1级组，bRFS的调整后风险比，2、3、4和5级组分别为1.98、4.20、5.57和9.32（P<0.001），RP分级组分别为2.09、5.27、5.86和10.42（P<0.001）。与常用的三级系统（Gleason评分6 vs 7 vs 8-10）相比，五级分组系统具有更高的预后辨别力。
在一个独立的手术队列中，我们验证了新的前列腺癌分级分组系统对bRFS的预后益处，并表明在调整重要的临床病理变量后该益处依然存在。新系统更高的预测准确性将改善临床环境中的风险分层，并有助于患者咨询。
