科研之友
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摘要
Gleason score (GS) plays an important role in determining the biology of prostate cancer but prognostic information is scanty. A total of 966 patients with paired biopsy and radical prostatectomy histology were enrolled from 8 academic hospitals in China from January 2005 to March 2013, with median follow-up of 53 months. Kaplan-Meier curves and multivariate models were generated to compare the GS upgrade to those in whom the Gleason score remains the same on the risk of postoperative biochemical recurrence/progression and death. Overall, 331 patients (34.26%) experienced a GS upgrade post Radical Prostatectomy (RP). We found that patients with upgraded GS experienced a significantly higher rate of biochemical recurrence/clinical progression/death/cancer-specific mortality compared to those with concordant GS (P<0.001). According to the biopsy GS, patients were divided into 3 groups (biopsy GS <= 6, GS=7, and GS >= 8), patients with upgraded GS suffered a significantly higher biochemical recurrence (P<0.005) than those with concordant GS in the 3 groups. In multivariate models, a change in GS was an independent predictor of biochemical recurrence (2.01 (1.45-2.80), P<0.001), progression (1.77 (1.06-2.96), P=0.003) and death (1.83 (0.83-4.04), P=0.036) in the preoperative setting only. Patients experiencing an upgrade in their GS between biopsy and post RP exhibited significantly more aggressive pathological features than corresponding concordant tumors, and a higher risk of biochemical recurrence/progression and death post RP.
