Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115 USA.
Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 02215 USA.
Hum Pathol. 2020 May;99:62-74. doi: 10.1016/j.humpath.2020.03.001. Epub 2020 Mar 11.
Implementation of Grade Groups (GrGrs) has been widely accepted for reporting prostate cancer grade since the 2014 International Society of Urological Pathology consensus meeting. Despite their undisputed value for risk stratification, some GrGr are, a priori, quite heterogeneous in that they contain multiple Gleason patterns (GPs). In this regard, the prognostic significance of GP5 in biopsies with highest GrGr4 is uncertain and evaluated in this study. A search of all core biopsies positive for prostate cancer reviewed after 2005 was performed, and 71 cases with highest GrGr4 containing GP5 (i.e., 3 + 5 = 8 or 5 + 3 = 8; referred to as GrGr4/GP5pos) eligible for inclusion were identified. In addition, 95 core biopsy cases with highest GrGr4 and no GP5 (i.e, 4 + 4 = 8; referred to as GrGr4/GP5neg) were selected for comparison. Multiple pathologic parameters, including volume and amount of GP4, and clinical variables were collected to evaluate the influence of GP5 on disease recurrence, development of metastases, and disease-specific death. GrGr4/GP5pos cases did not show, as a group, statistically significant differences in prostatectomy findings, disease recurrence, metastases, and disease-specific mortality when compared with GrGr4/GP5neg cases. In addition, the risk of all outcomes evaluated in the study did not differ between the whole GrGr4/GP5pos and GrGr4/GP5neg groups. However, Kaplan-Meier analysis found that GrGr4/GP5pos cases with a significant amount of GP4 did show a higher risk of prostate cancer-specific death as well as bone and visceral metastases. Univariate Cox regression demonstrated that preoperative prostate specific antigen (PSA), total number of positive cores, and global GrGr5 were also associated with a higher chance of disease-specific death. In a multivariate model, only global GrGr5 and PSA >20 ng/dL remained statistically significant. This study suggests that the mere presence of GP5 in core biopsies with highest GrGr4 disease may not portend a worse prognosis. In these cases, accounting for the case-wide volume of GP4 by reporting a global GrGr appears to be more relevant as it identifies a subset of GrGr4/GP5pos patients with global GrGr5 who have a higher risk of metastases and prostate cancer-specific mortality.
自 2014 年国际泌尿病理学会共识会议以来，用于报告前列腺癌分级的分级分组（GrGrs）已被广泛接受。尽管它们在风险分层方面具有无可争议的价值，但某些 GrGr 在理论上是相当异质的，因为它们包含多个 Gleason 模式（GP）。在这方面，活检中最高 GrGr4 中 GP5 的预后意义尚不确定，本研究对此进行了评估。对 2005 年后复查的所有前列腺癌核心活检进行了搜索，共发现 71 例最高 GrGr4 中含有 GP5（即 3+5=8 或 5+3=8；称为 GrGr4/GP5pos）符合纳入标准。此外，还选择了 95 例最高 GrGr4 且无 GP5（即 4+4=8；称为 GrGr4/GP5neg）的核心活检病例进行比较。收集了包括 GP4 体积和数量在内的多个病理参数以及临床变量，以评估 GP5 对疾病复发、转移和疾病特异性死亡的影响。与 GrGr4/GP5neg 病例相比，GrGr4/GP5pos 病例作为一个整体在前列腺切除术发现、疾病复发、转移和疾病特异性死亡率方面没有统计学上的显著差异。此外，在研究中评估的所有结局的风险在整个 GrGr4/GP5pos 和 GrGr4/GP5neg 组之间没有差异。然而，Kaplan-Meier 分析发现，GP4 含量显著的 GrGr4/GP5pos 病例确实具有更高的前列腺癌特异性死亡以及骨转移和内脏转移风险。单因素 Cox 回归表明，术前前列腺特异性抗原（PSA）、阳性核心总数和整体 GrGr5 也与疾病特异性死亡的可能性增加相关。在多变量模型中，只有整体 GrGr5 和 PSA＞20ng/dL 仍具有统计学意义。本研究表明，在最高 GrGr4 疾病的核心活检中仅存在 GP5 可能不会预示预后更差。在这些情况下，通过报告整体 GrGr 来计算 GP4 的整体体积似乎更为相关，因为它确定了一组具有更高转移和前列腺癌特异性死亡率风险的 GrGr4/GP5pos 患者。
