Qiu Jianhui, Cai Desheng, Wang Zixin, Zhou Jingcheng, Gong Yanqing, Cai Lin, Gong Kan
Department of Urology, Peking University First Hospital, Beijing, China.
Institute of Urology, Peking University, Beijing, China.
Front Oncol. 2021 Apr 26;11:633312. doi: 10.3389/fonc.2021.633312. eCollection 2021.
Gleason score (GS) system is one of the most widely used histological grading methods for prostate cancer (PCa) all over the world. GS can be obtained by adding the primary Gleason pattern (GP) and secondary GP. Different proportions of GP 4 and GP 5 in prostate specimens can both lead to GS 9. In this study, we explored whether GP 5 + 4 or GP 4 + 5 was associated with different prognoses among patients with GS 9 PCa. A retrospective population-based study was conducted on 10,124 subjects diagnosed with GS 9 PCa between 2004 and 2009 from the Surveillance, Epidemiology, and End Results program. A 1:1 propensity-score matching (PSM) was performed to balance the baseline characteristics between the GP 4 + 5 and 5 + 4 groups and to compare the prognoses between the two groups. Cox regression analysis and Fine-Gray competing risk regression models were adopted to screen the covariates significantly associated with all-cause mortality (ACM) and cancer-specific mortality (CAM). GP 5 + 4 was associated with higher risks of ACM and CSM before or after PSM than GP 4 + 5. In the original cohort, there were eight independent predictors for ACM, which were age at diagnosis, race, AJCC NM stage, PSA levels, treatments, GP, and marital status, confirmed by the Cox analysis; and nine independent predictors for CSM, which were age at diagnosis, race, AJCC TNM stage, PSA levels, treatments, GP, and marital status, confirmed by the competing-risk model. GP 5 + 4 was associated with a poorer overall survival and cancer-specific survival compared with GP 4 + 5.
格里森评分（GS）系统是全球应用最广泛的前列腺癌（PCa）组织学分级方法之一。GS可通过将主要格里森模式（GP）和次要GP相加得出。前列腺标本中不同比例的GP 4和GP 5均可导致GS为9。在本研究中，我们探讨了在GS为9的PCa患者中，GP 5 + 4或GP 4 + 5是否与不同预后相关。我们对2004年至2009年间监测、流行病学和最终结果计划中诊断为GS为9的PCa的10124名受试者进行了一项基于人群的回顾性研究。进行了1:1倾向评分匹配（PSM）以平衡GP 4 + 5组和5 + 4组之间的基线特征，并比较两组之间的预后。采用Cox回归分析和Fine-Gray竞争风险回归模型筛选与全因死亡率（ACM）和癌症特异性死亡率（CAM）显著相关的协变量。与GP 4 + 5相比，PSM前后GP 5 + 4与更高的ACM和CSM风险相关。在原始队列中，Cox分析证实有8个ACM的独立预测因素，即诊断时年龄、种族、美国癌症联合委员会（AJCC）NM分期、前列腺特异性抗原（PSA）水平、治疗、GP和婚姻状况；竞争风险模型证实有9个CSM的独立预测因素，即诊断时年龄、种族、AJCC TNM分期、PSA水平、治疗、GP和婚姻状况。与GP 4 + 5相比，GP 5 + 4与更差的总生存期和癌症特异性生存期相关。
