Mathieu R, Moschini M, Beyer B, Gust K M, Seisen T, Briganti A, Karakiewicz P, Seitz C, Salomon L, de la Taille A, Rouprêt M, Graefen M, Shariat S F
Comprehensive Cancer Center, Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria.
Department of Urology, Rennes University Hospital, Rennes, France.
Prostate Cancer Prostatic Dis. 2017 Jun;20(2):197-202. doi: 10.1038/pcan.2016.66. Epub 2017 Jan 10.
We aimed to assess the prognostic relevance of the new Grade Groups in Prostate Cancer (PCa) within a large cohort of European men treated with radical prostatectomy (RP).
Data from 27 122 patients treated with RP at seven European centers were analyzed. We investigated the prognostic performance of the new Grade Groups (based on Gleason score 3+3, 3+4, 4+3, 8 and 9-10) on biopsy and RP specimen, adjusted for established clinical and pathological characteristics. Multivariable Cox proportional hazards regression models assessed the association of new Grade Groups with biochemical recurrence (BCR). Prognostic accuracies of the models were assessed using Harrell's C-index.
Median follow-up was 29 months (interquartile range, 13-54). The 4-year estimated BCR-free survival (bRFS) for biopsy Grade Groups 1-5 were 91.3, 81.6, 69.8, 60.3 and 44.4%, respectively. The 4-year estimated bRFS for RP Grade Groups 1-5 were 96.1%, 86.7%, 67.0%, 63.1% and 41.0%, respectively. Compared with Grade Group 1, all other Grade Groups based both on biopsy and RP specimen were independently associated with a lower bRFS (all P<0.01). Adjusted pairwise comparisons revealed statistically differences between all Grade Groups, except for group 3 and 4 on RP specimen (P=0.10). The discriminations of the multivariable base prognostic models based on the current three-tier and the new five-tier systems were not clinically different (0.3 and 0.9% increase in discrimination for clinical and pathological model).
We validated the independent prognostic value of the new Grade Groups on biopsy and RP specimen from European PCa men. However, it does not improve the accuracies of prognostic models by a clinically significant margin. Nevertheless, this new classification may help physicians and patients estimate disease aggressiveness with a user-friendly, clinically relevant and reproducible method.
我们旨在评估在接受根治性前列腺切除术（RP）的大量欧洲男性队列中，前列腺癌（PCa）新分级组的预后相关性。
分析了来自欧洲七个中心的27122例接受RP治疗的患者的数据。我们研究了新分级组（基于Gleason评分3+3、3+4、4+3、8和9-10）在活检和RP标本上的预后性能，并根据既定的临床和病理特征进行了调整。多变量Cox比例风险回归模型评估了新分级组与生化复发（BCR）的关联。使用Harrell's C指数评估模型的预后准确性。
中位随访时间为29个月（四分位间距，13-54）。活检分级组1-5的4年估计无BCR生存率（bRFS）分别为91.3%、81.6%、69.8%、60.3%和44.4%。RP分级组1-5的4年估计bRFS分别为96.1%、86.7%、67.0%、63.1%和41.0%。与分级组1相比，基于活检和RP标本的所有其他分级组均与较低的bRFS独立相关（所有P<0.01）。调整后的成对比较显示，除RP标本上的分级组3和4外，所有分级组之间均存在统计学差异（P=0.10）。基于当前三层系统和新五层系统的多变量基础预后模型的辨别力在临床上无差异（临床和病理模型的辨别力分别增加0.3%和0.9%）。
我们验证了新分级组在欧洲PCa男性活检和RP标本上的独立预后价值。然而，它并没有在临床上显著提高预后模型的准确性。尽管如此，这种新分类可能有助于医生和患者用一种用户友好、临床相关且可重复的方法估计疾病侵袭性。
