Gleason score 5+3=8 prostate cancer: much more like Gleason score 9?
Gleason score 5+3=8 prostate cancer: much more like Gleason score 9?
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DOI：
10.1111/bju.13239
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发表时间：
2016-07-01
影响因子：
4.5
通讯作者：
Nguyen, Paul L.
中科院分区：
文献类型：
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作者：
Mahal, Brandon A.;Muralidhar, Vinayak;Nguyen, Paul L.
目的确定Gleason评分为5 + 3 = 8的前列腺癌患者的结局是否与Gleason评分为8的其他患者或Gleason评分为9的患者更相似。流行病学和最终结果（SEER）数据库用于研究2004年至2011年诊断为N 0 M0 Gleason评分8或9前列腺癌的40533名男性。以Gleason评分4 + 4 = 8为参照，Fine和Gray竞争风险回归分析模拟了Gleason评分与前列腺癌特异性死亡率（PCSM）之间的关系。和13.9%（P < 0.001）。Gleason评分为5 + 3 = 8或9的患者发生PCSM的风险增加2倍（校正后的危险比[AHR] 1.89，95%可信区间[CI] 1.50-2.38，P < 0.001; AHR 2.17，95%CI 1.99-2.36，P < 0.001）与参考组患者（Gleason评分4 + 4 = 8）相比。Gleason评分5 + 3 = 8与9疾病的患者之间PCSM无差异（P = 0.25）。Gleason评分3 + 5 = 8和Gleason 4 + 4 = 8疾病的PCSM相似，但Gleason评分5 + 3 = 8的患者发生PCSM的风险是其他Gleason评分8疾病患者的两倍，应被视为与Gleason评分9疾病患者具有相似的不良预后。这些患者应该被允许参加寻找最高风险患者的试验，以测试新的积极治疗策略。
ObjectiveTo determine whether patients with Gleason score 5 + 3 = 8 prostate cancer have outcomes more similar to other patients with Gleason score 8 disease or to patients with Gleason score 9 disease.Patients and MethodsThe Surveillance, Epidemiology and End Results (SEER) database was used to study 40 533 men diagnosed with N0M0 Gleason score 8 or 9 prostate cancer from 2004 to 2011. Using Gleason score 4 + 4 = 8 as the referent, Fine and Gray competing risks regression analyses modelled the association between Gleason score and prostate cancer-specific mortality (PCSM).ResultsThe 5-year PCSM rates for patients with Gleason score 4 + 4 = 8, 3 + 5 = 8, 5 + 3 = 8, and 9 disease were 6.3%, 6.6%, 13.5%, and 13.9%, respectively (P < 0.001). Patients with Gleason score 5 + 3 = 8 or 9 disease had up to a two-fold increased risk of PCSM (adjusted hazard ratio [AHR] 1.89, 95% confidence interval [CI] 1.50-2.38, P < 0.001; and AHR 2.17, 95% CI 1.99-2.36, P < 0.001, respectively) compared with the referent group of patients (Gleason score 4 + 4 = 8). There was no difference in PCSM between patients with Gleason score 5 + 3 = 8 vs 9 disease (P = 0.25).ConclusionsGleason score 8 disease represents a heterogeneous entity with PCSM outcomes distinguishable by the primary Gleason pattern. The PCSM of Gleason score 3 + 5 = 8 and Gleason 4 + 4 = 8 disease are similar, but patients with Gleason score 5 + 3 = 8 have a risk of PCSM that is twice as high as other patients with Gleason score 8 disease and should be considered to have a similar poor prognosis as patients with Gleason score 9 disease. Such patients should be allowed onto trials seeking the highest-risk patients in which to test novel aggressive treatment strategies.