Biopsy Detected Gleason Pattern 5 is Associated with Recurrence, Metastasis and Mortality in a Cohort of Men with High Risk Prostate Cancer.
Biopsy Detected Gleason Pattern 5 is Associated with Recurrence, Metastasis and Mortality in a Cohort of Men with High Risk Prostate Cancer.
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DOI：
10.1016/j.juro.2017.07.009
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发表时间：
2017-12
期刊：
影响因子：
--
通讯作者：
Freedland SJ
中科院分区：
文献类型：
--
作者：
Stroup SP;Moreira DM;Chen Z;Howard L;Berger JH;Terris MK;Aronson WJ;Cooperberg MR;Amling CL;Kane CJ;Freedland SJ
我们评估了前列腺癌生化复发、转移和死亡的相对风险，这些风险是由活检Gleason模式5在Gleason 8-10疾病的高危男性中的相对风险。对经根治性前列腺切除术治疗的前列腺癌活检Gleason sum 8-10的男性进行了评价。该队列分为Gleason 4 + 4型男性与任何模式5型男性（即Gleason 3 + 5，5 + 3，4 + 5，5 + 4或5 + 5）。采用Kaplan-Meier、对数秩检验和考克斯比例风险模型分析生化复发、转移和前列腺癌特异性和总生存期的预测因子。我们在SEARCH数据库中确定了634名高风险男性，其中394名（62%）活检为格里森4 + 4型，240名（38%）活检为格里森5型。两组之间的基线特征无显著差异。在相对于格里森4 + 4的格里森模式5高风险男性的多变量分析中，生化复发风险没有差异（HR 1.26，95%CI 0.99-1.61，p = 0.065）。然而，他们的转移风险（HR 2.55，95% CI 1.50-4.35，p = 0.001）、前列腺癌特异性死亡率（HR 2.67，95% CI 0.1.26-5.66，p = 0.010）和总死亡率（HR 1.60，95% CI 1.09-2.34，p = 0.016）显著更高。通过活检Gleason分级（4 + 4 vs任何Gleason模式5）对高危前列腺癌进行术前亚分类，确定男性进展风险最高。任何活检的Gleason 5与转移的更大风险以及前列腺癌特异性和总体死亡率相关。将所有Gleason 8-10肿瘤一起作为高风险病变可能无法完全将男性分层为最高风险的不良结局。
We evaluated the relative risk of biochemical recurrence, metastasis and death from prostate cancer contributed by biopsy Gleason pattern 5 among men at high risk with Gleason 8–10 disease in the SEARCH (Shared Equal Access Regional Cancer Hospital) cohort. Men with biopsy Gleason sum 8–10 prostate cancer treated with radical prostatectomy were evaluated. The cohort was divided into men with Gleason 4 + 4 vs those with any pattern 5 (ie Gleason 3 + 5, 5 + 3, 4 + 5, 5 + 4 or 5 + 5). Predictors of biochemical recurrence, metastases, and prostate cancer specific and overall survival were analyzed using Kaplan-Meier, log rank test and Cox proportional hazards models. We identified 634 men at high risk in the SEARCH database, of whom 394 (62%) had Gleason 4 + 4 and 240 (38%) had Gleason pattern 5 on biopsy. Baseline characteristics did not significantly differ between the groups. On multivariable analysis relative to Gleason 4 + 4 men at high risk with Gleason pattern 5 showed no difference in the risk of biochemical recurrence (HR 1.26, 95% CI 0.99–1.61, p = 0.065). However, they were at significantly greater risk for metastasis (HR 2.55, 95% CI 1.50–4.35, p = 0.001), prostate cancer specific mortality (HR 2.67, 95% CI 0.1.26–5.66, p = 0.010) and overall mortality (HR 1.60, 95% CI 1.09–2.34, p = 0.016). Preoperative subclassification of high risk prostate cancer by biopsy Gleason grade (4 + 4 vs any Gleason pattern 5) identified men at highest risk for progression. Any Gleason 5 on biopsy is associated with a greater risk of metastasis, and prostate cancer specific and overall mortality. Grouping all Gleason 8–10 tumors together as high risk lesions may fail to fully stratify men at highest risk for poor outcomes.
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