Icahn School of Medicine, The Mount Sinai Hospital, New York, NY.
Icahn School of Medicine, The Mount Sinai Hospital, New York, NY.
Urol Oncol. 2020 Mar;38(3):78.e15-78.e21. doi: 10.1016/j.urolonc.2019.10.009. Epub 2019 Dec 1.
Presently, prostate biopsy (PBx) results report the highest Gleason Grade Group (GGG) as a single metric that gauges the overall clinical aggressiveness of cancer and dictates treatment. We hypothesized a PBx showing multiple cores of cancer with more volume cancer per core would represent more aggressive disease. We propose the Weighted Gleason Grade Group (WGGG), a novel scoring system that synthesizes all histopathologic data and cancer volume into a single numeric value representing the entire PBx, allowing for improved prediction of adverse pathology and risk of biochemical recurrence (BCR) following radical prostatectomy (RP).
We studied 171 men who underwent RP after standard PBx. The WGGG was calculated by summing each positive core using the formula: GGG + (GGG x %Ca/core). RP pathology was evaluated for extraprostatic extension (EPE), positive surgical margins (PSM), seminal vesicle invasion (SVI), and lymph node involvement (LNI), and patients were followed for BCR. We compared GGG vs. WGGG receiver operating characteristic curves for each outcome, and determined the predictive capability of GGG and WGGG to identify patients with BCR. Categorized WGGG groups were created based on risk of BCR using classification and regression tree analysis. We then sought to externally validate WGGG in a cohort of 389 patients in a separate institutional dataset.
In the development cohort, area under the curves (AUCs) for the WGGG vs. GGG were significantly higher for predicting EPE (0.784 vs. 0.690, P = 0.002), SVI (AUC 0.823 vs. 0.721, P = .014), LNI (AUC 0.862 vs. 0.823, P = 0.039), and PSM (AUC 0.638 vs. 0.575, P = 0.031. Analysis of the validation cohort showed similar findings for EPE (AUC 0.764 vs. 0.729, P = 0.13), SVI (AUC 0.819 vs. 0.749, P = 0.01), LNI (AUC 0.939 vs. 0.867, P = 0.02), and PSM (AUC 0.624 vs. 0.547, P = 0.04). Patients with WGGG >30 (high-risk group) demonstrated ∼50% failure at 2 years in both cohorts.
The WGGG, by providing a metric reflecting the entirety of the PBx, is more informative than conventional single GGG alone in identifying adverse pathologic outcomes and risk of BCR following RP. This superior discriminatory capability has been achieved without any consideration of other commonly available clinical disease characteristics.
目前，前列腺活检（PBx）结果报告的最高 Gleason 分级组（GGG）是评估癌症整体临床侵袭性和决定治疗的单一指标。我们假设 PBx 显示多个核心的癌症，每个核心的癌症体积更大，这代表更具侵袭性的疾病。我们提出了加权 Gleason 分级组（WGGG），这是一种新的评分系统，它将所有组织病理学数据和癌症体积综合成一个单一的数值，代表整个 PBx，从而能够更好地预测前列腺癌根治术后的不良病理和生化复发（BCR）风险。
我们研究了 171 名接受标准 PBx 后接受前列腺癌根治术的男性。WGGG 通过以下公式计算每个阳性核心的总和：GGG+（GGG x %Ca/core）。对前列腺癌根治术病理进行了评估，包括前列腺外扩展（EPE）、阳性手术边缘（PSM）、精囊侵犯（SVI）和淋巴结受累（LNI），并对患者进行了 BCR 随访。我们比较了 GGG 与 WGGG 对每种结果的受试者工作特征曲线，并确定了 GGG 和 WGGG 对识别 BCR 患者的预测能力。根据 BCR 的风险，使用分类和回归树分析创建了分类 WGGG 组。然后，我们在另一个机构数据集的 389 名患者的队列中寻求 WGGG 的外部验证。
在开发队列中，WGGG 与 GGG 相比，预测 EPE（AUC 0.784 与 0.690，P=0.002）、SVI（AUC 0.823 与 0.721，P=0.014）、LNI（AUC 0.862 与 0.823，P=0.039）和 PSM（AUC 0.638 与 0.575，P=0.031）的曲线下面积（AUC）显著更高。对验证队列的分析显示，EPE（AUC 0.764 与 0.729，P=0.13）、SVI（AUC 0.819 与 0.749，P=0.01）、LNI（AUC 0.939 与 0.867，P=0.02）和 PSM（AUC 0.624 与 0.547，P=0.04）的发现也相似。WGGG＞30（高危组）的患者在两个队列中均在 2 年内出现约 50%的失败。
WGGG 通过提供反映整个 PBx 的指标，在识别前列腺癌根治术后不良病理结果和 BCR 风险方面，比传统的单一 GGG 更具信息性。这种优越的鉴别能力是在不考虑其他常用临床疾病特征的情况下实现的。
