根治性前列腺切除术时，通过整体肿瘤分级估计的癌症分级和 Gleason 模式 4 的百分比与 2 级和 3 级癌症生化复发风险的相关性与通过个体肿瘤分级估计的结果不同。
Radical prostatectomy cancer grade and percentage of Gleason pattern 4 estimated by global vs individual tumor grading correlate differently with the risk of biochemical recurrence in Grade Group 2 and 3 cancers.
机构信息
Department of Pathology & Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, US.
Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, US.
出版信息
Am J Clin Pathol. 2024 Jul 5;162(1):51-61. doi: 10.1093/ajcp/aqae003.
OBJECTIVES
There are 2 grading approaches to radical prostatectomy (RP) in multifocal cancer: Grade Group (GG) and percentage of Gleason pattern 4 (GP4%). We investigated whether RP GG and GP4% generated by global vs individual tumor grading correlate differently with biochemical recurrence.
METHODS
We reviewed 531 RP specimens with GG2 or GG3 cancer. Each tumor was scored separately with assessment of tumor volume and GP4%. Global grade and GP4% were assigned by combining Gleason pattern 3 and 4 volumes for all tumors. Correlation of GG and GP4% generated by 2 methods with biochemical recurrence was assessed by Cox proportional hazard regression and receiver operating characteristic curves, with optimism adjustment using a bootstrap analysis.
RESULTS
Median age was 63 (range, 42-79) years. Median prostate-specific antigen was 6.3 (range, 0.3-62.9) ng/mL. In total, the highest-grade tumor in 371 (36.9%) men was GG2 and in 160 (30.1%) men was GG3. Global grading was downgraded from GG3 to GG2 in 37 of 121 (30.6%) specimens with multifocal disease, and 145 of 404 (35.9%) specimens had GP4% decreased by at least 10%. Ninety-eight men experienced biochemical recurrence within a median of 13 (range, 3-119) months. Men without biochemical recurrence were followed up for a median of 47 (range, 12-205) months. Grade Group, GP4%, and margin status correlated with the risk of biochemical recurrence using highest-grade tumor and global grading, but the degrees of these correlations varied and were statistically significantly different between the 2 grading approaches.
CONCLUSIONS
Grade Group, GP4%, and margin status derived by global vs individual tumor grading predict postoperative biochemical recurrence statistically significantly differently. This difference has important implications if results derived from cohorts graded using different methods are compared.
目的
多灶性前列腺癌有两种根治性前列腺切除术（RP）的分级方法：分级组（GG）和 4 级 Gleason 模式（GP4%）百分比。我们研究了整体肿瘤分级与个别肿瘤分级的 RP GG 和 GP4%是否与生化复发的相关性不同。
方法
我们回顾了 531 例 GG2 或 GG3 癌症的 RP 标本。对每个肿瘤进行单独评分，并评估肿瘤体积和 GP4%。通过组合所有肿瘤的 3 和 4 级 Gleason 模式体积，对整体等级和 GP4%进行赋值。使用 Cox 比例风险回归和受试者工作特征曲线评估 2 种方法生成的 GG 和 GP4%与生化复发的相关性，并使用 bootstrap 分析进行乐观调整。
结果
中位年龄为 63 岁（范围，42-79 岁）。中位前列腺特异性抗原为 6.3（范围，0.3-62.9）ng/mL。共有 371 名（36.9%）男性中最高级别肿瘤为 GG2，160 名（30.1%）男性中最高级别肿瘤为 GG3。在有多处病变的 121 例标本中，有 37 例（30.6%）整体分级从 GG3 降为 GG2，在 404 例标本中有 145 例（35.9%）GP4%至少降低 10%。98 名男性在中位时间 13（范围，3-119）个月后发生生化复发。无生化复发的男性中位随访时间为 47（范围，12-205）个月。使用最高级别肿瘤和整体分级，GG、GP4%和切缘状态与生化复发的风险相关，但这些相关性的程度不同，在这 2 种分级方法之间存在统计学显著差异。
结论
整体肿瘤分级与个别肿瘤分级的 GG、GP4%和切缘状态预测术后生化复发的统计学差异显著。如果比较使用不同方法分级的队列的结果，这种差异具有重要意义。
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