Grogan Judith, Gupta Ruta, Mahon Kate L, Stricker Phillip D, Haynes Anne-Maree, Delprado Warick, Turner Jennifer, Horvath Lisa G, Kench James G
Cancer Research Program, Kinghorn Cancer Centre/Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.
Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
BJU Int. 2017 Nov;120(5):651-658. doi: 10.1111/bju.13857. Epub 2017 Apr 30.
To assess the relationship between the International Society of Urological Pathology (ISUP) 2014 grading system, biochemical recurrence (BCR) and clinical recurrence (CLR) after radical prostatectomy (RP), to determine whether the 2014 ISUP grading system is a better predictor of survival compared with the previous Gleason scoring systems, and to investigate whether incorporation of the tertiary pattern/grade into the ISUP scoring system significantly improves its efficacy.
A total of 635 RP cases (1991-1999) were identified from a database at a single institution. A histopathology review was performed to re-grade the cases as per the ISUP 2014 grading system. All relevant clinicopathological data and clinical follow-up (median [range] 15.25 [0.3-26] years) were obtained. Log-rank, Kaplan-Meier, Cox regression and Harrell's concordance c-indices analyses were performed.
At a median follow-up of 15 years, 276 patients (44%) had BCR and 41 (7%) had CLR. Grade Groups 1, 2, 3, 4 and 5 were seen in 112 (18%), 307 (48%), 129 (20%), 33 (5%) and 54 patients (9%), respectively: 337 (53%) were upgraded, while 70 (11%) were downgraded compared with the 1992 Gleason system. Grade Group (hazard ratio [HR] 4.9; P < 0.001) and preoperative prostate-specific antigen (PSA) level (HR 1.4; P < 0.001) were independent predictors of BCR. Only Grade Group 5 (HR 12.3; P = 0.02), preoperative PSA (HR 1.6; P < 0.001), stage pT3b (HR 3.1; P = 0.03) and pT4 (HR 12.4; P < 0.001) independently predicted CLR. Harrell's c-indices showed that the 2014 ISUP grading system was a significantly better predictor of BCR and CLR as well as prostate cancer-specific death, compared with the 2005 ISUP modified Gleason system. The replacement of the secondary pattern by the tertiary pattern did not alter the prognostic efficacy of the ISUP 2014 grading system.
The ISUP 2014 grading system is a significant independent predictor of both BCR and CLR, outperforming the 2005 ISUP modified Gleason system. This classification system has the potential to influence clinical decision-making after RP.
评估国际泌尿病理学会（ISUP）2014年分级系统与根治性前列腺切除术（RP）后生化复发（BCR）及临床复发（CLR）之间的关系，确定2014年ISUP分级系统与既往Gleason评分系统相比是否为更好的生存预测指标，并研究将三级模式/分级纳入ISUP评分系统是否能显著提高其效能。
从单一机构的数据库中识别出635例RP病例（1991 - 1999年）。进行组织病理学复查，按照ISUP 2014年分级系统对病例重新分级。获取所有相关的临床病理数据及临床随访资料（中位[范围]15.25[0.3 - 26]年）。进行对数秩检验、Kaplan - Meier分析、Cox回归分析及Harrell一致性c指数分析。
中位随访15年时，276例患者（44%）发生BCR，41例患者（7%）发生CLR。1级、2级、3级、4级和5级组分别见于112例（18%）、307例（48%）、129例（20%）、33例（5%）和54例患者（9%）：与1992年Gleason系统相比，337例（53%）病例分级上调，70例（11%）病例分级下调。分级组（风险比[HR]4.9；P < 0.001）及术前前列腺特异性抗原（PSA）水平（HR 1.4；P < 0.001）是BCR的独立预测因素。仅5级组（HR 12.3；P = 0.02）、术前PSA（HR 1.6；P < 0.001）、pT3b期（HR 3.1；P = 0.03）和pT4期（HR 12.4；P < 0.001）独立预测CLR。Harrell c指数显示，与2005年ISUP改良Gleason系统相比，2014年ISUP分级系统对BCR、CLR以及前列腺癌特异性死亡的预测能力显著更好。用三级模式替代二级模式并未改变ISUP 2014年分级系统的预后效能。
ISUP 2014年分级系统是BCR和CLR的重要独立预测指标，优于2005年ISUP改良Gleason系统。该分类系统有可能影响RP后的临床决策。
