Size-adjusted Quantitative Gleason Score as a Predictor of Biochemical Recurrence after Radical Prostatectomy

作者：Deng Fang Ming; Donin Nicholas M^*; Benito Ruth Pe; Melamed Jonathan; Le Nobin Julien; Zhou Ming; Ma Sisi; Wang Jinhua; Lepor Herbert

来源：European Urology, 2016, 70(2): 248-253.

DOI：10.1016/j.eururo.2015.10.026

• Gleason score
• Humans
• Prognosis
• Risk assessment
• Prostatectomy
• Tumor volume
• Neoplasm grading
• Neoplasm recurrence
• Prostatic neoplasms

Background: The risk of biochemical recurrence (BCR) following radical prostatectomy for pathologic Gleason 7 prostate cancer varies according to the proportion of Gleason 4 component.
Objective: We sought to explore the value of several novel quantitative metrics of Gleason 4 disease for the prediction of BCR in men with Gleason 7 disease.
Design, setting, and participants: We analyzed a cohort of 2630 radical prostatectomy cases from 1990-2007. All pathologic Gleason 7 cases were identified and assessed for quantity of Gleason pattern 4. Three methods were used to quantify the extent of Gleason 4: a quantitative Gleason score (qGS) based on the proportion of tumor composed of Gleason pattern 4, a size-weighted score (swGS) incorporating the overall quantity of Gleason 4, and a size index (siGS) incorporating the quantity of Gleason 4 based on the index lesion.
Outcome measurements and statistical analysis: Associations between the above metrics and BCR were evaluated using Cox proportional hazards regression analysis.
Results and limitations: qGS, swGS, and siGS were significantly associated with BCR on multivariate analysis when adjusted for traditional Gleason score, age, prostate specific antigen, surgical margin, and stage. Using Harrell's c-index to compare the scoring systems, qGS (0.83), swGS (0.84), and siGS (0.84) all performed better than the traditional Gleason score (0.82).
Conclusions: Quantitative measures of Gleason pattern 4 predict BCR better than the traditional Gleason score.
Patient summary: In men with Gleason 7 prostate cancer, quantitative analysis of the proportion of Gleason pattern 4 (quantitative Gleason score), as well as size-weighted measurement of Gleason 4 (size-weighted Gleason score), and a size-weighted measurement of Gleason 4 based on the largest tumor nodule significantly improve the predicted risk of biochemical recurrence compared with the traditional Gleason score.

• 出版日期2016-8