Lu Thomas Chengxuan, Moretti Kim, Beckmann Kerri, Cohen Penelope, O'Callaghan Michael
University of Adelaide, Adelaide, Australia.
Royal Adelaide Hospital, Adelaide, Australia.
Pathol Oncol Res. 2018 Oct;24(4):921-925. doi: 10.1007/s12253-017-0331-2. Epub 2017 Oct 27.
The International Society of Urological Pathology (ISUP) and the World Health Organisation have adopted a five-tiered prognostic grade group for prostate cancer in 2014. Grade group 4 is comprised of Gleason patterns 4 + 4, 3 + 5 and 5 + 3. Recent articles have suggested heterogeneity in their prognostic outcomes. We aimed to determine whether there was a difference in mortality outcomes within the ISUP 4 grouping, as identified on needle biopsy. A total of 4080 men who were diagnosed with non-metastatic (N0 M0) prostate cancer on biopsy with Gleason scores of 7, 8 and 9 were included. Multi-variable Cox Regression and Fine and Grey competing risk analysis were used to determine the All-Cause Mortality (ACM) and the Prostate Cancer Specific Mortality (PCSM) as a function of Gleason Scores (Gleason 3 + 4, 4 + 3, 4 + 4, 3 + 5/5 + 3, 9). Gleason score 4 + 4 was utilized as the referent. The 60 months' prostate cancer specific mortality with Gleason patterns 4 + 4 and 3 + 5/5 + 3 were 17% and 20% respectively (P < 0.01). Patients with 3 + 5/5 + 3 disease, had no statistically significant difference in the ACM (adjusted hazard ratio [aHR] 0.99, 95% confidence interval [Cl] 0.68-1.4, p = 0.99) and PCSM risk (aHR 0.77, 95% Cl 0.47-1.2, p = 0.31) when compare with the referent group of patients. Patients with Gleason patterns 4 + 3 and 9 had statistically significant difference in their PCSM risk (aHR 0.70, 95% CI 0.54-0.91, P < 0.001 and aHR 1.5, 95% Cl 1.2-1.9, P < 0.001) when compared to the referent group. Our analysis suggest that ISUP group 4 is homogenous in terms of the all-cause mortality and the prostate cancer specific morality risk as differentiated by the presence of Gleason 5 score.
国际泌尿病理学会（ISUP）和世界卫生组织于2014年采用了前列腺癌的五级预后分级组。4级组由 Gleason 模式 4 + 4、3 + 5 和 5 + 3 组成。近期文章表明它们的预后结果存在异质性。我们旨在确定在针吸活检中确定的 ISUP 4 级分组内的死亡率结果是否存在差异。共纳入了4080名经活检诊断为非转移性（N0 M0）前列腺癌且 Gleason 评分为7、8和9的男性。采用多变量 Cox 回归和 Fine 和 Grey 竞争风险分析来确定全因死亡率（ACM）和前列腺癌特异性死亡率（PCSM）与 Gleason 评分（Gleason 3 + 4、4 + 3、4 + 4、3 + 5/5 + 3、9）的函数关系。将 Gleason 评分 4 + 4 用作参照。Gleason 模式 4 + 4 和 3 + 5/5 + 3 的60个月前列腺癌特异性死亡率分别为17%和20%（P < 0.01）。与参照组患者相比，3 + 5/5 + 3 疾病患者的 ACM（调整后风险比[aHR] 0.99，95%置信区间[Cl] 0.68 - 1.4，p = 0.99）和 PCSM 风险（aHR 0.77，95% Cl 0.47 - 1.2，p = 0.31）无统计学显著差异。与参照组相比，Gleason 模式 4 + 3 和 9 的患者在其 PCSM 风险方面存在统计学显著差异（aHR 0.70，95% CI 0.54 - 0.91，P < 0.001 和 aHR 1.5，95% Cl 1.2 - 1.9，P < 0.001）。我们的分析表明，就全因死亡率和前列腺癌特异性死亡风险而言，ISUP 4级组根据是否存在 Gleason 5评分是同质的。
