Percentage of Gleason pattern 4 and 5 predicts survival after radical prostatectomy

Percentage of Gleason pattern 4 and 5 predicts survival after radical prostatectomy
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DOI：
10.1002/cncr.23004
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发表时间：
2007-11-01
期刊：
CANCER
影响因子：
6.2
通讯作者：
Koch, Michael O.
Koch, Michael O.
中科院分区：
医学1区
文献类型：
--
作者：
Cheng, Liang;Davidson, Darrell D.;Koch, Michael O.

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背景在前列腺癌中，肿瘤分级的形态学和临床异质性是公认的。当前研究的目的是确定根治性前列腺切除术标本中格里森模式4和5的组合百分比是否是前列腺癌患者癌症特异性生存的独立预测因素。方法。根治性前列腺切除术标本来自1990年至1998年间在印第安纳州大学医学中心接受治疗的504例连续前列腺癌患者。分析各种临床和病理特征。Gleason 4型和5型的合并百分比较高与年龄较大、术前血清前列腺特异性抗原水平较高、病理分期较高、手术切缘阳性、肿瘤向前列腺外延伸、Gleason评分较高、神经周围浸润和淋巴结转移有关。在多变量考克斯回归模型中，Gleason模式4和5的组合百分比被发现是癌症特异性生存的独立预测因子（P = 0.04）。Gleason模式4和5的组合百分比是前列腺癌特异性生存的有力预测因子。对高级别癌症数量的评估可以更好地将患者分层为适当的预后组和治疗方案。
BACKGROUND. Morphologic and clinical heterogeneity within tumor grades is well recognized in prostate cancer. The objective of the current study was to determine whether the combined percentage of Gleason patterns 4 and 5 in radical prostatectomy specimens is an independent predictor of cancer-specific survival in prostate cancer patients.METHOD. The radical prostatectomy specimens were analyzed from 504 consecutive prostate cancer patients who were treated at Indiana University Medical Center between 1990 and 1998. Various clinical and pathologic characteristics were analyzed.RESULTS. A higher combined percentage of Gleason patterns 4 and 5 was associated with older age, higher preoperative serum prostate- specific antigen level, higher pathologic stage, positive surgical margins, extraprostatic extension of tumor, higher Gleason score, perineural invasion, and lymph node metastasis. In the multivariate Cox regression model, the combined percentage of Gleason patterns 4 and 5 was found to be an independent predictor of cancer-specific survival (P =.04).CONCLUSIONS. The combined percentage of Gleason patterns 4 and 5 is a powerful predictor of prostate cancer-specific survival. Assessment of high-grade cancer amounts may allow for better stratification of patients into appropriate prognostic groups and treatment protocols.