Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
J Urol. 2017 Apr;197(4):1060-1067. doi: 10.1016/j.juro.2016.11.079. Epub 2016 Nov 12.
Gleason score is one of the most important prognostic indicators for prostate cancer. Downgrading from biopsy Gleason score 7 to radical prostatectomy Gleason score 6 occurs commonly and yet to our knowledge the impact on survival outcomes is unknown. We examined biochemical recurrence and prostate cancer specific mortality risk in a large cohort evaluated by a single group of expert urological pathologists.
Of 23,918 men who underwent radical prostatectomy at our institution between 1984 and 2014, 10,236 with biopsy and radical prostatectomy Gleason score 6 or 7 without upgrading were included in analysis. The cohort was divided into 3 groups, including group 1-biopsy and radical prostatectomy Gleason score 6 in 6,923 patients (67.6%), group 2-Gleason score 7 downgraded to radical prostatectomy Gleason score 6 in 648 (6.3%) and group 3-biopsy and radical prostatectomy Gleason score 7 in 2,665 (26.0%). Biochemical recurrence and prostate cancer specific mortality risks were compared using Cox regression and competing risk analyses adjusting for clinicopathological variables.
At a median followup of 5 years (range 1 to 29), 992 men experienced biochemical recurrence and 95 had died of prostate cancer. Biochemical recurrence-free survival in downgraded cases (group 2) was better than in group 3 cases, which had Gleason score 7 on biopsy and radical prostatectomy (p <0.001), but worse than group 1 cases, which had Gleason score 6 on biopsy and radical prostatectomy (p <0.001). Downgrading was independently associated with biochemical recurrence (adjusted HR 1.87, p <0.0001) but not with prostate cancer specific mortality (adjusted HR 1.65, p = 0.636).
Downgrading from biopsy Gleason score 7 to radical prostatectomy Gleason score 6 was an independent predictor of biochemical recurrence but not prostate cancer specific mortality, likely due to the presence of minor amounts of Gleason pattern 4.
格里森评分是前列腺癌最重要的预后指标之一。从活检格里森评分 7 降级到根治性前列腺切除术格里森评分 6 很常见，但据我们所知，其对生存结果的影响尚不清楚。我们检查了由一组专家泌尿科病理学家评估的大量队列的生化复发和前列腺癌特异性死亡率。
在我们机构，1984 年至 2014 年间，23918 名接受根治性前列腺切除术的男性中，有 10236 名男性的活检和根治性前列腺切除术格里森评分 6 或 7 无升级，包括在分析中。该队列分为 3 组，包括第 1 组-活检和根治性前列腺切除术格里森评分 6，6923 例患者（67.6%），第 2 组-格里森评分 7 降级为根治性前列腺切除术格里森评分 6，648 例（6.3%），第 3 组-活检和根治性前列腺切除术格里森评分 7，2665 例（26.0%）。使用 Cox 回归和竞争风险分析，在调整临床病理变量后，比较生化复发和前列腺癌特异性死亡率的风险。
中位随访 5 年（范围 1 至 29），992 名男性发生生化复发，95 名男性死于前列腺癌。降级病例（第 2 组）的生化无复发生存率优于活检和根治性前列腺切除术格里森评分 7 的病例（第 3 组）（p<0.001），但比活检和根治性前列腺切除术格里森评分 6 的病例（第 1 组）差（p<0.001）。降级与生化复发独立相关（调整后的 HR 1.87，p<0.0001），但与前列腺癌特异性死亡率无关（调整后的 HR 1.65，p=0.636）。
从活检格里森评分 7 降级到根治性前列腺切除术格里森评分 6 是生化复发的独立预测因素，但不是前列腺癌特异性死亡率的独立预测因素，这可能是由于存在少量格里森模式 4。
