Best Oliver, Canagasingham Ashan, Liu Zhixin, Doan Paul, Haynes Anne-Maree, Delprado Warick, Maclean Fiona, Yuen Carlo, Stricker Phillip, Thompson James
Department of Urology, St George Hospital, Kogarah, NSW, Australia; Kinghorn Cancer Centre, Garvan Institute, Darlinghurst, NSW, Australia.
Department of Urology, St George Hospital, Kogarah, NSW, Australia; Kinghorn Cancer Centre, Garvan Institute, Darlinghurst, NSW, Australia.
Pathology. 2023 Jun;55(4):492-497. doi: 10.1016/j.pathol.2022.10.012. Epub 2023 Jan 11.
The pathological grade of prostate cancer is the strongest predictor of recurrence. It is unclear whether the better predictor is the composite of all carcinomas within the prostate, or the highest grade lesion (index). The purpose of this study was to determine whether composite or index grade group better predicts biochemical recurrence (BCR). We undertook a retrospective analysis from a prospective institutional cohort study of men who underwent radical prostatectomy for localised prostate cancer between 2009 and 2020, in which an index and composite grade group was reported. The index grade in this study was defined as the highest grade of any tumour, usually with the highest stage, regardless of volume. Multivariate analysis and Kaplan-Meier plots were utilised. A total of 2024 men underwent radical prostatectomy during the study period; we analysed 1605 with composite grade group 2 or 3 prostate cancer. Median preoperative prostate specific antigen (PSA) was 5.9 ng/L, mean follow up was 56.8 months, 54% were pT2, 76% had multifocal disease and 16% had discordant index and composite grades. Patients with discordant index grade group had a higher risk of BCR [hazard ratio (HR) 2.22, p<0.0001]. The prevalence of BCR in the discordant group was higher at 1, 3, 5 and 7 years (4.7% vs 8.9%, 8.3% vs 18.1%, 14.5% vs 28.8% and 22.5% vs 49.5%, respectively). In cases of discordance, a higher index grade group is associated with increased rates of BCR after radical prostatectomy. Index rather than composite grade group should be used to counsel men post-operatively regarding prognosis and follow-up.
前列腺癌的病理分级是复发的最强预测指标。目前尚不清楚更好的预测指标是前列腺内所有癌灶的综合情况，还是最高分级的病灶（指数）。本研究的目的是确定综合分级组还是指数分级组能更好地预测生化复发（BCR）。我们对2009年至2020年间因局限性前列腺癌接受根治性前列腺切除术的男性进行了一项前瞻性机构队列研究的回顾性分析，该研究报告了指数分级和综合分级组。本研究中的指数分级定义为任何肿瘤的最高分级，通常是最高分期，不考虑体积。采用多变量分析和Kaplan-Meier曲线。在研究期间，共有2024名男性接受了根治性前列腺切除术；我们分析了1605例综合分级为2级或3级前列腺癌的患者。术前前列腺特异性抗原（PSA）中位数为5.9 ng/L，平均随访56.8个月，54%为pT2期，76%有多灶性疾病，16%的指数分级和综合分级不一致。指数分级组不一致的患者发生BCR的风险更高[风险比（HR）2.22，p<0.0001]。不一致组在1年、3年、5年和7年时BCR的发生率更高（分别为4.7%对8.9%、8.3%对18.1%、14.5%对28.8%和22.5%对49.5%）。在分级不一致的情况下，较高的指数分级组与根治性前列腺切除术后BCR发生率增加相关。术后应使用指数分级组而非综合分级组为男性提供预后和随访咨询。
