Predictive value of the 2014 International Society of Urological Pathology grading system for prostate cancer in patients undergoing radical prostatectomy with long-term follow-up
Predictive value of the 2014 International Society of Urological Pathology grading system for prostate cancer in patients undergoing radical prostatectomy with long-term follow-up
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DOI：
10.1111/bju.13857
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发表时间：
2017-11-01
影响因子：
4.5
通讯作者：
Kench, James G.
中科院分区：
文献类型：
--
作者：
Grogan, Judith;Gupta, Ruta;Kench, James G.
目的评估国际泌尿外科病理学会（ISUP）2014年分级系统与根治性膀胱癌切除术（RP）后生化复发（BCR）和临床复发（CRH）的关系，以确定2014年ISUP分级系统是否比以前的Gleason评分系统更好地预测生存，并调查是否纳入三级模式/等级到ISUP评分系统显着提高其effictiveness.Patients and MethodsA共635 RP情况下（1991-1999年），确定从一个数据库中的一个单一的机构。根据ISUP 2014分级系统进行组织病理学审查，对病例进行重新分级。获得所有相关临床病理学数据和临床随访（中位[范围] 15.25 [0.3-26]年）。Log-rank，Kaplan-Meier，考克斯回归和Harrell的一致性c-indicsanalyses.ResultsAt中位随访15年，276例（44%）有BCR和41（7%）有复发。分级组1、2、3、4和5分别见于112（18%）、307（48%）、129（20%）、33（5%）和54例患者（9%）：与1992年Gleason系统相比，337例（53%）升级，70例（11%）降级。分级组（风险比[HR] 4.9; P < 0.001）和术前前列腺特异性抗原（PSA）水平（HR 1.4; P < 0.001）是BCR的独立预测因子。只有5级组（HR 12.3; P = 0.02）、术前PSA（HR 1.6; P < 0.001）、pT 3b（HR 3.1; P = 0.03）和pT 4（HR 12.4; P < 0.001）独立预测了乳腺癌。Harrell的c指数显示，与2005年ISUP改良的Gleason系统相比，2014年ISUP分级系统是BCR和Risk以及前列腺癌特异性死亡的显著更好的预测因子。由第三模式的第二模式的替代并没有改变的ISUP 2014分级system.ConclusionsThe ISUP 2014分级系统的预后疗效是一个显着的独立预测BCR和BCR，优于2005年ISUP修改格里森系统。该分类系统有可能影响RP后的临床决策。
ObjectiveTo assess the relationship between the International Society of Urological Pathology (ISUP) 2014 grading system, biochemical recurrence (BCR) and clinical recurrence (CLR) after radical prostatectomy (RP), to determine whether the 2014 ISUP grading system is a better predictor of survival compared with the previous Gleason scoring systems, and to investigate whether incorporation of the tertiary pattern/grade into the ISUP scoring system significantly improves its efficacy.Patients and MethodsA total of 635 RP cases (1991-1999) were identified from a database at a single institution. A histopathology review was performed to re-grade the cases as per the ISUP 2014 grading system. All relevant clinicopathological data and clinical follow-up (median [range] 15.25 [0.3-26] years) were obtained. Log-rank, Kaplan-Meier, Cox regression and Harrell's concordance c-indices analyses were performed.ResultsAt a median follow-up of 15years, 276 patients (44%) had BCR and 41 (7%) had CLR. Grade Groups 1, 2, 3, 4 and 5 were seen in 112 (18%), 307 (48%), 129 (20%), 33 (5%) and 54 patients (9%), respectively: 337 (53%) were upgraded, while 70 (11%) were downgraded compared with the 1992 Gleason system. Grade Group (hazard ratio [HR] 4.9; P < 0.001) and preoperative prostate-specific antigen (PSA) level (HR 1.4; P < 0.001) were independent predictors of BCR. Only Grade Group 5 (HR 12.3; P = 0.02), preoperative PSA (HR 1.6; P < 0.001), stage pT3b (HR 3.1; P = 0.03) and pT4 (HR 12.4; P < 0.001) independently predicted CLR. Harrell's c-indices showed that the 2014 ISUP grading system was a significantly better predictor of BCR and CLR as well as prostate cancer-specific death, compared with the 2005 ISUP modified Gleason system. The replacement of the secondary pattern by the tertiary pattern did not alter the prognostic efficacy of the ISUP 2014 grading system.ConclusionsThe ISUP 2014 grading system is a significant independent predictor of both BCR and CLR, outperforming the 2005 ISUP modified Gleason system. This classification system has the potential to influence clinical decision-making after RP.