Integrating tertiary Gleason pattern 5 into the ISUP grading system improves prediction of biochemical recurrence in radical prostatectomy patients

被引：15

作者：

Kato, Masashi ^{[1
]}

Hirakawa, Akihiro ^{[2
]}

Kobayashi, Yumiko ^{[3
]}

Yamamoto, Akiyuki ^{[1
]}

Ishida, Ryo ^{[4
]}

Kamihira, Osamu ^{[5
]}

Kimura, Tohru ^{[6
]}

Majima, Tsuyoshi ^{[1
]}

Ishida, Shohei ^{[1
]}

Funahashi, Yasuhito ^{[1
]}

Sassa, Naoto ^{[1
]}

Fujita, Takashi ^{[1
]}

Matsukawa, Yoshihisa ^{[1
]}

Yamamoto, Tokunori ^{[1
]}

Hattori, Ryohei ^{[7
]}

Gotoh, Momokazu ^{[1
]}

Tsuzuki, Toyonori ^{[8
]}

机构：

[1] Nagoya Univ, Grad Sch Med, Dept Urol, Nagoya, Aichi, Japan

[2] Univ Tokyo, Grad Sch Med, Dept Biostat & Bioinformat, Tokyo, Japan

[3] Nagoya Univ Hosp, Stat Anal Sect, Ctr Adv Med & Clin Res, Nagoya, Aichi, Japan

[4] Japanese Red Cross Nagoya Daini Hosp, Dept Urol, Nagoya, Aichi, Japan

[5] Komaki City Hosp, Dept Urol, Komaki, Aichi, Japan

[6] JCHO Chukyo Hosp, Dept Urol, Nagoya, Aichi, Japan

[7] Japanese Red Cross Nagoya Daiichi Hosp, Dept Urol, Nagoya, Aichi, Japan

[8] Aichi Med Univ, Sch Med, Dept Surg Pathol, Nagakute, Aichi, Japan

来源：

MODERN PATHOLOGY | 2019年 / 32卷 / 01期

关键词：

PROGNOSTIC-SIGNIFICANCE; CANCER; HETEROGENEITY; PROPOSAL; BIOPSY;

D O I：

10.1038/s41379-018-0121-8

中图分类号：

R36 [病理学];

学科分类号：

100104 ;

摘要：

Although the presence of tertiary Gleason pattern 5 is reportedly related to unfavorable prostate cancer characteristics, few data are available regarding the effects of tertiary Gleason pattern 5 on the new ISUP (International Society of Urological Pathology) grading system in radical prostatectomy patients. In this study, we evaluated the effect of tertiary Gleason pattern 5 on biochemical recurrence following radical prostatectomy in patients with prostate cancer. We retrospectively evaluated 1000 patients with prostate cancer who underwent radical prostatectomy. The ISUP Grades were as follows: Grade 1, 16.3%; Grade 2, 48.1% (with tertiary Gleason pattern 5, 8.0% and without tertiary Gleason pattern 5, 40.1%); Grade 3, 21.9% (with tertiary Gleason pattern 5, 9.1% and without tertiary Gleason pattern 5, 12.8%); Grade 4, 3.9%; and Grade 5, 9.8%. Biochemical recurrence-free survival differed significantly among the five groups (Grade 1-5) (P < 0.0001). Grade 2 with tertiary Gleason pattern 5 had a significantly worse prognosis than Grade 2 without tertiary Gleason pattern 5. Similarly, Grade 3 with tertiary Gleason pattern 5 demonstrated a significantly worse prognosis than Grade 3 without tertiary Gleason pattern 5. When Grade 2 and Grade 3 were divided with or without tertiary Gleason pattern 5, the survival curves differed significantly among Grade 1, Grade 2 without tertiary Gleason pattern 5, Grade 2 with tertiary Gleason pattern 5, Grade 3 without tertiary Gleason pattern 5, Grade 3 with tertiary Gleason pattern 5, and Grade 4 (P < 0.0001) (hazard ratios: 1, 1.14, 1.86, 2.23, 3.53, and 6.30). In a multivariate analysis, integrating tertiary Gleason pattern 5 into the ISUP Grade, PSA, and surgical margin status significantly predicted biochemical recurrence (P < 0.0001). Integrating tertiary Gleason pattern 5 into the ISUP grading system will improve the accuracy of patient outcome prediction following radical prostatectomy in patients with prostate cancer.

引用

页码：122 / 127

页数：6

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