Department of Urology, Nagoya University Graduate School of Medicine, 65 Tsumai-cho, Showa-ku, Nagoya, Japan.
Division of Biostatistics and Data Science, Clinical Research Center, Tokyo Medical and Dental University Tokyo, Tokyo, Japan.
Int J Clin Oncol. 2021 Apr;26(4):764-769. doi: 10.1007/s10147-020-01841-4. Epub 2021 Jan 1.
It has been argued that grade group 2 (GG2) with a low Gleason pattern 4 (GP4) proportion should be an indication for active surveillance (AS) of prostate cancer (PCa). However, the cut-off GP4 proportion for AS remains unclear. Here, we evaluated the effect of GP4 proportion and IDC-P on cancer recurrence following radical prostatectomy (RP) in GG1 and GG2 patients, and identified candidates for AS.
We retrospectively evaluated 646 patients with PCa who underwent RP between 2005 and 2014, and whose specimens were of GG1 or GG2 status.
The GGs were as follows: GG1, 25.2% (n = 163); GG2 (5% ≥ GP4), 11.4% (n = 74); GG2 (5% < GP4 ≤ 10%), 25.9% (n = 167); and GG2 (20% ≤ GP4), 37.5% (n = 242). IDC-P was detected in 26 patients (4%), i.e., in 2/167 GG2 (5% < GP4 ≤ 10%; 1%) cases and 24/242 GG2 (20% ≤ GP4; 10%) cases. GG2 patients with IDC-P exhibited a significantly poorer prognosis than did those without IDC-P (P < 0.0001), as did GG2 (20% ≤ GP4) patients without IDC-P (P < 0.05). The GG2 (5% ≥ GP4) and (5% < GP4 ≤ 10%) groups exhibited prognoses similar to those of the GG1 patients. In multivariate analysis, GG2 (20% ≤ GP4) without IDC-P, the presence of IDC-P, and the prostate-specific antigen level at diagnosis significantly predicted prognosis (P < 0.05, < 0.0001, and < 0.0001, respectively).
Our findings suggest that GG2 (GP4 ≤ 10%) patients could be indicated for AS, similar to GG1 patients, given the risk of IDC-P tumors.
有人认为，低 Gleason 模式 4（GP4）比例的 2 级（GG2）应作为前列腺癌（PCa）主动监测（AS）的指征。然而，用于 AS 的 GP4 比例截止值仍不清楚。在这里，我们评估了 GP4 比例和 IDC-P 对 GG1 和 GG2 患者根治性前列腺切除术后（RP）癌症复发的影响，并确定了 AS 的候选者。
我们回顾性评估了 2005 年至 2014 年间接受 RP 治疗的 646 例 PCa 患者，其标本为 GG1 或 GG2 状态。
GG 为：GG1，25.2%（n=163）；GG2（5%≥GP4），11.4%（n=74）；GG2（5%<GP4≤10%），25.9%（n=167）；GG2（20%≤GP4），37.5%（n=242）。26 例（4%）检测到 IDC-P，即 2/167 GG2（5%<GP4≤10%；1%）病例和 24/242 GG2（20%≤GP4；10%）病例。IDC-P 阳性的 GG2 患者的预后明显差于无 IDC-P 阳性的患者（P<0.0001），无 IDC-P 阳性的 GG2（20%≤GP4）患者的预后也明显差于无 IDC-P 阳性的患者（P<0.05）。GG2（5%≥GP4）和（5%<GP4≤10%）组的预后与 GG1 患者相似。多变量分析显示，无 IDC-P 的 GG2（20%≤GP4）、IDC-P 的存在以及诊断时的前列腺特异性抗原水平显著预测预后（P<0.05，P<0.0001 和 P<0.0001）。
我们的研究结果表明，鉴于 IDC-P 肿瘤的风险，GG2（GP4≤10%）患者可考虑进行 AS，类似于 GG1 患者。
