The Effect of Differing Gleason Scores at Biopsy on the Odds of Upgrading and the Risk of Death From Prostate Cancer |
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| Affiliation: | 1. Harvard Radiation Oncology Program, Boston, MA;2. Department of Statistics, University of Connecticut, Storrs, CT;3. Department of Pathology, Brigham and Women''s Hospital, Boston, MA;4. Division of Urology, Department of Surgery, Brigham and Women''s Hospital, Boston, MA;5. Division of MRI, Department of Radiology, Brigham and Women''s Hospital, Boston, MA;6. Harvard Medical School, Boston, MA;7. Department of Radiation Oncology, Brigham and Women''s Hospital and Dana-Farber Cancer Institute, Boston, MA;1. Department of Radiotherapy, Imperial College Healthcare NHS Trust, London, UK;2. Department of Radiation Physics and Radiobiology, Imperial College Healthcare NHS Trust, London, UK;1. Faculty of Medicine, McGill University, Montreal, Quebec, Canada;2. Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada;3. Calgary Laboratory Services, University of Calgary, Calgary, Alberta, Canada;1. Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland;2. Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada;3. Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada;4. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan;1. Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany;2. European Cyberknife Center Munich, Munich, Germany;3. Division of Surgical Oncology, Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands;1. Department of Radiation Oncology, University of California, Los Angeles, California;2. David Geffen School of Medicine at UCLA, Los Angeles, California;3. 21st Century Oncology, Fort Myers, Florida;4. Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio;5. Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto;6. Humanitas Research Hospital, Radiotherapy and Radiosurgery Department, Rozzano, Milan, Italy;7. Humanitas University, Department of Biomedical Sciences, Rozzano, Milan, Italy;8. Department of Radiation Oncology, Lankenau Medical Center Main Line Health, Wynnewood, Pennsylvania;9. Lankenau Institute for Medical Research, Wynnewood, Pennsylvania;10. Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania;11. Department of Radiation Oncology, VA Greater Los Angeles Health care System, Los Angeles, California;1. School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, Australia;2. Genesis CancerCare Queensland, The Wesley Medical Centre, Suite 1, 40 Chasely St, Auchenflower, QLD 4066, Australia |
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| Abstract: | Introduction/BackgroundThe GS is an established prostate cancer prognostic factor. Whether the presence of differing GSs at biopsy (eg, 4+3 and 3+3), which we term ComboGS, improves the prognosis that would be predicted based on the highest GS (eg, 4+3) because of decreased upgrading is unknown. Therefore, we evaluated the odds of upgrading at time of radical prostatectomy (RP) and the risk of PCSM when ComboGS was present versus absent.Patients and MethodsLogistic and competing risks regression were performed to assess the effect that ComboGS had on the odds of upgrading at time of RP in the index (n = 134) and validation cohorts (n = 356) and the risk of PCSM after definitive therapy in a long-term cohort (n = 666), adjusting for known predictors of these end points. We calculated and compared the area under the curve using a receiver operating characteristic analysis when ComboGS was included versus excluded from the upgrading models.ResultsComboGS was associated with decreased odds of upgrading (index: adjusted odds ratio [AOR], 0.14; 95% confidence interval [CI], 0.04-0.50; P = .003; validation: AOR, 0.24; 95% CI, 0.11-0.51; P < .001) and added significantly to the predictive value of upgrading for the in-sample index (P = .02), validation (P = .003), and out-of-sample prediction models (P = .002). ComboGS was also associated with a decreased risk of PCSM (adjusted hazard ratio, 0.40; 95% CI, 0.19-0.85; P = .02).ConclusionDiffering biopsy GSs are associated with a lower odds of upgrading and risk of PCSM. If validated, future randomized noninferiority studies evaluating deescalated treatment approaches in men with ComboGS could be considered. |
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| Keywords: | ComboGS Pathology Prognostic factors Prostate cancer-specific mortality Radical prostatectomy |
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