Tertiary Gleason pattern in radical prostatectomy specimens is associated with worse outcomes than the next higher Gleason score group in localized prostate cancer

被引:10
作者
Oezsoy, Mehmet [1 ,2 ]
D'Andrea, David [1 ]
Moschini, Marco [1 ,3 ]
Foerster, Beat [1 ,4 ]
Abufaraj, Mohammad [1 ,5 ]
Mathieu, Romain [1 ,6 ]
Briganti, Alberto [3 ]
Karakiewicz, Pierre I. [7 ]
Roupret, Morgan [8 ]
Seitz, Christian [1 ,2 ]
Czech, Anna Katarzyna [9 ]
Susani, Martin [10 ]
Shariat, Shahrokh F. [1 ,2 ,11 ,12 ]
机构
[1] Med Univ Vienna, Vienna Gen Hosp, Ctr Comprehens Canc, Dept Urol, Vienna, Austria
[2] Karl Landsteiner Soc, Urol & Androl, Vienna, Austria
[3] Univ Vita Salute San Raffaele, Urol Res Inst, San Raffaele Sci Inst, Dept Urol, Milan, Italy
[4] Kantonspital Winterthur, Dept Urol, Winterthur, Switzerland
[5] Univ Jordan, Jordan Univ Hosp, Div Urol, Dept Special Surg, Amman, Jordan
[6] Univ Rennes, Dept Urol, Rennes, France
[7] Univ Montreal, Canc Prognost & Hlth Outcomes Unit, Hlth Ctr, Montreal, PQ, Canada
[8] Univ Paris, Pitie Salpetriere Hosp, Dept Urol, Paris, France
[9] Jagiellonian Univ, Dept Urol, Coll Med, Krakow, Poland
[10] Med Univ Vienna, Vienna Gen Hosp, Clin Inst Pathol, Vienna, Austria
[11] Weill Cornell Med Coll, Dept Urol, New York, NY 10065 USA
[12] Univ Texas Southwestern Med Ctr Dallas, Dept Urol, Dallas, TX 75390 USA
关键词
Tertiary Gleason pattern; Prostate cancer; Biochemical recurrence; Radical prostatectomy; Gleason score; ISUP CONSENSUS-CONFERENCE; LYMPHOVASCULAR INVASION; ADENOCARCINOMA; VALIDATION; CARCINOMA; GRADE;
D O I
10.1016/j.urolonc.2017.12.003
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Aim: To assess the predictive value of TGP on biochemical recurrence (BCR) and its association with clinicopathological outcomes in a large, multicenter cohort of patients with localized prostate cancer (PCa) treated with radical prostatectomy (RP). Materials and methods: Records of 6,041 patients who were treated with RP between 2000 and 2011 for clinically nonmetastatic PCa were, retrospectively, analyzed from prospectively collected datasets. BCR-free survival rates were assessed using univariable and multivariable cox-regression analyses. Results: Median patient age was 61 years (interquartile range [IQR]: 57-66) with a median preoperative prostrate specific antigen of 6 ng/ml (IQR: 4-9). Overall, 28% of patients had Gleason score (GS) 6, 0.3% GS 6 + TGP, 33% GS 7 (3 + 4), 0.2% GS 7 (3 + 4) + TGP, 22% GS 7 (4 + 3), 0.2% GS 7 (4 + 3) + TGP, 0.1% GS 8 and 0.4% GS 9 or 10. Median follow-up was 45 months (IQR: 31-57). Harboring a TGP was associated with higher rates of positive surgical margins, lymphovascular invasion, extraprostatic extension, and seminal vesicle invasion than their counterparts within the same GS group as well as in the next higher GS group (all P <= 0.05). At 5 years post-RP, BCR estimates were 5% for patients with GS 6, 13% for patients with GS 6 + TGP, 6% for patients with GS 7 (3 + 4), 22% for patients with GS 7 (3 + 4) + TGP, 16% for patients with GS 7 (4 + 3), 41% for patients with GS 7 (4 + 3) + TGP, 38% for patients with GS 8 (4 + 4) and 46% for patients with GS 9 or 10. Patients harboring a TGP had higher BCR rates than the patients in the next higher GS group: GS 6 + TGP vs. GS 7 (3 + 4), HR = 1.6, P = 0.02 and GS 7 (3 + 4)+TGP vs. GS 7 (4 + 3), HR = 1.4, P = 0.03. Patients with a TGP in the GS 7 (4 + 3) group had comparable BCR rates as patients with GS = 8 (P = 0.4) and GS 9 to 10 (P = 0.2). On multivariable analysis that adjusted for the effects of preoperative prostrate specific antigen, nodal involvement, positive surgical margin, extraprostatic disease (pT3a), seminal vesicle invasion (pT3b) and different institution, harboring a TGP showed higher risk of developing BCR within the same GS group and comparable risk of developing BCR with the next higher GS group. Conclusion: Patients with TGP at RP have adverse clinicopathological features when compared to their counterparts in the same and the next higher GS group without TGP. Risk of developing BCR increases with the presence of TGP within the same GS group. This risk seems to be comparable between patients with TGP and their counterparts in the next higher GS group without TGP. Knowledge of TGP in RP specimens is likely to improve risk stratification, patient counseling and follow-up scheduling. Further prospective studies that control significant clinical endpoints such as metastasis and mortality are necessary for more significant predictions. (C) 2017 Elsevier Inc. All rights reserved.
引用
收藏
页码:158.e1 / 158.e6
页数:6
相关论文
共 28 条
  • [1] A Tertiary Gleason Pattern in the Prostatectomy Specimen and its Association with Adverse Outcome after Radical Prostatectomy
    Adam, Meike
    Hannah, Amir
    Budaeus, Lars
    Steuber, Thomas
    Salomon, Georg
    Michl, Uwe
    Haese, Alexander
    Fisch, Margit
    Wittmer, Corinna
    Steurer, Stefan
    Minner, Sarah
    Heinzer, Hans
    Huland, Hartwig
    Graefen, Markus
    Sauter, Guido
    Schlomm, Thorsten
    Isbarn, Hendrik
    [J]. JOURNAL OF UROLOGY, 2014, 192 (01) : 97 - 101
  • [2] Metastatic potential to regional lymph nodes with Gleason score ≤7, including tertiary pattern 5, at radical prostatectomy
    Diolombi, Mairo L.
    Epstein, Jonathan I.
    [J]. BJU INTERNATIONAL, 2017, 119 (06) : 872 - 878
  • [3] Clinical Significance of Prospectively Assigned Gleason Tertiary Pattern 4 in Contemporary Gleason Score 3+3=6 Prostate Cancer
    Doshi, Chirag
    Vacchio, Michael
    Attwood, Kristopher
    Murekeyisoni, Christine
    Mehedint, Diana C.
    Badkhshan, Shervin
    Azabdaftari, Gissou
    Sule, Norbert
    Guru, Khurshid A.
    Mohler, James L.
    Kauffman, Eric C.
    [J]. PROSTATE, 2016, 76 (08) : 715 - 721
  • [4] Interactive digital slides with heat maps: a novel method to improve the reproducibility of Gleason grading
    Egevad, Lars
    Algaba, Ferran
    Berney, Daniel M.
    Boccon-Gibod, Liliane
    Comperat, Eva
    Evans, Andrew J.
    Grobholz, Rainer
    Kristiansen, Glen
    Langner, Cord
    Lockwood, Gina
    Lopez-Beltran, Antonio
    Montironi, Rodolfo
    Oliveira, Pedro
    Schwenkglenks, Matthias
    Vainer, Ben
    Varma, Murali
    Verger, Vincent
    Camparo, Philippe
    [J]. VIRCHOWS ARCHIV, 2011, 459 (02) : 175 - 182
  • [5] The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma
    Epstein, JI
    Allsbrook, WC
    Amin, MB
    Egevad, LL
    Bastacky, S
    Beltrán, AL
    Berner, A
    Billis, A
    Boccon-Gibod, L
    Cheng, L
    Civantos, F
    Cohen, C
    Cohen, MB
    Datta, M
    Davis, C
    Delahunt, B
    Delprado, W
    Eble, JN
    Foster, CS
    Furusato, M
    Gaudin, PB
    Grignon, DJ
    Humphrey, PA
    Iczkowski, KA
    Jones, EC
    Lucia, S
    McCue, PA
    Nazeer, T
    Oliva, E
    Pan, CC
    Pizov, G
    Reuter, V
    Samaratunga, H
    Sebo, T
    Sesterhenn, I
    Shevchuk, M
    Srigley, JR
    Suzigan, S
    Takahashi, H
    Tamboli, P
    Tan, PH
    Têtu, B
    Tickoo, S
    Tomaszewski, JE
    Troncoso, P
    Tsuzuki, T
    True, LD
    van der Kwast, T
    Wheeler, TM
    Wojno, KJ
    [J]. AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 2005, 29 (09) : 1228 - 1242
  • [6] Contemporary Gleason Grading of Prostatic Carcinoma An Update With Discussion on Practical Issues to Implement the 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma
    Epstein, Jonathan I.
    Amin, Mahul B.
    Reuter, Victor E.
    Humphrey, Peter A.
    [J]. AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 2017, 41 (04) : E1 - E7
  • [7] Proposed Morphologic Classification of Prostate Cancer With Neuroendocrine Differentiation
    Epstein, Jonathan I.
    Amin, Mahul B.
    Beltran, Himisha
    Lotan, Tamara L.
    Mosquera, Juan-Miguel
    Reuter, Victor E.
    Robinson, Brian D.
    Troncoso, Patricia
    Rubin, Mark A.
    [J]. AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 2014, 38 (06) : 756 - 767
  • [8] Upgrading and Downgrading of Prostate Cancer from Biopsy to Radical Prostatectomy: Incidence and Predictive Factors Using the Modified Gleason Grading System and Factoring in Tertiary Grades
    Epstein, Jonathan I.
    Feng, Zhaoyong
    Trock, Bruce J.
    Pierorazio, Phillip M.
    [J]. EUROPEAN UROLOGY, 2012, 61 (05) : 1019 - 1024
  • [9] PREDICTION OF PROGNOSIS FOR PROSTATIC ADENOCARCINOMA BY COMBINED HISTOLOGICAL GRADING AND CLINICAL STAGING
    GLEASON, DF
    MELLINGE.GT
    [J]. JOURNAL OF UROLOGY, 1974, 111 (01) : 58 - 64
  • [10] Tertiary Gleason Pattern 5 and Oncological Outcomes after Radical Prostatectomy
    Hashine, Katsuyoshi
    Yuasa, Akihito
    Shinomori, Kensuke
    Shirato, Akitomi
    Ninomiya, Iku
    Teramoto, Norihiro
    [J]. JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 2011, 41 (04) : 571 - 576