Egevad Lars, Micoli Chiara, Samaratunga Hemamali, Delahunt Brett, Garmo Hans, Stattin Pär, Eklund Martin
Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Eur Urol Oncol. 2024 Apr;7(2):213-221. doi: 10.1016/j.euo.2023.11.002. Epub 2023 Nov 17.
Since 2014, prostate cancer is reported using five-tier grouping of Gleason scores. Studies have suggested prognostic heterogeneity within the groups.
We assessed the risk of prostate cancer death for men diagnosed with Gleason scores 4 + 5, 5 + 4, and 5 + 5 on needle biopsy in a population-based cohort.
DESIGN, SETTING, AND PARTICIPANTS: We used the data from Prostate Cancer data Base Sweden (PCBaSe) 4.0 for a survival analysis. Among 199 620 men reported to have prostate cancer in 2000-2020, 172 112 were diagnosed on needle biopsy. The primary treatment was classified as androgen deprivation therapy (66%), deferred treatment (5%), radical prostatectomy (7%), or radical radiotherapy (21%).
The risks of death from prostate cancer in men with Gleason score 9-10 at 5 and 10 yr were used as endpoints. Multivariable Cox regression models controlling for socioeconomic factors and primary treatment were used for time-to-event analyses of death from prostate cancer and death from any causes.
A total of 20 419 (12%) men had a Gleason score of 9-10, including Gleason scores of 4 + 5, 5 + 4, and 5 + 5 in 14 333 (70%), 4223 (21%), and 1863 (9%) men, respectively. The risks of prostate cancer death for men with Gleason scores 4 + 5, 5 + 4, and 5 + 5 at 10 yr of follow-up were 0.45 (confidence interval [CI] 0.44-0.46), 0.56 (0.55-0.58), and 0.66 (0.63-0.68), respectively. The risks of death of any cause for men with Gleason scores 4 + 5, 5 + 4, and 5 + 5 at 10 yr were 0.73 (CI 0.72-0.74), 0.81 (0.80-0.83), and 0.87 (0.85-0.89), respectively.
We demonstrate in the largest and most complete cohort analyzed to date that collapsing the Gleason scores by grouping results in loss of prognostic information in men with Gleason score 9-10 cancer.
Survival of prostate cancer patients with the highest tumor grades varies depending on grade composition.
自2014年以来，前列腺癌采用Gleason评分的五级分组报告。研究表明各分组内存在预后异质性。
我们在一项基于人群的队列研究中评估了经穿刺活检诊断为Gleason评分4+5、5+4和5+5的男性前列腺癌死亡风险。
设计、研究地点和参与者：我们使用瑞典前列腺癌数据库（PCBaSe）4.0的数据进行生存分析。在2000年至2020年报告患有前列腺癌的199620名男性中，172112名是经穿刺活检诊断的。主要治疗方法分为雄激素剥夺治疗（66%）、延迟治疗（5%）、根治性前列腺切除术（7%）或根治性放疗（21%）。
将Gleason评分9-10的男性在5年和10年时前列腺癌死亡风险作为终点。使用控制社会经济因素和主要治疗方法的多变量Cox回归模型对前列腺癌死亡和任何原因死亡进行事件发生时间分析。
共有20419名（12%）男性Gleason评分为9-10，其中Gleason评分4+5、5+4和5+5的男性分别有14333名（70%）、4223名（21%）和1863名（9%）。随访10年时，Gleason评分4+5、5+4和5+5的男性前列腺癌死亡风险分别为0.45（置信区间[CI]0.44-0.46）、0.56（0.55-0.58）和0.66（0.63-0.68）。随访10年时，Gleason评分4+5、5+4和5+5的男性任何原因死亡风险分别为0.73（CI 0.72-0.74）、0.81（0.80-0.83）和0.87（0.85-0.89）。
我们在迄今为止分析的最大且最完整的队列中证明，通过分组合并Gleason评分会导致Gleason评分9-10癌症男性的预后信息丢失。
肿瘤分级最高的前列腺癌患者的生存率因分级组成而异。
