BACKGROUND: There has been a recent proposal to change the grading system of prostate cancer into a five-tier grade grouping system. The prognostic impact of this has been demonstrated in regards only to biochemical recurrence-free survival (bRFS) with short follow-up (3 years). METHODS: Between 1990 and 2013, 847 consecutive men were treated with definitive external beam radiation therapy at a single academic center. To validate the new grade grouping system, bRFS, distant metastases-free survival (DMFS) and prostate cancer-specific survival (PCSS) were calculated. Adjusted Kaplan-Meier and multivariable Cox regression analyses were performed to assess the independent impact of the new grade grouping system. Discriminatory analyses were performed to compare the commonly used three-tier Gleason score system (6, 7 and 8-10) to the new system. RESULTS: The median follow-up of our cohort was 88 months. The 5-grade groups independently validated differing risks of bRFS (group 1 as reference; adjusted hazard ratio (aHR) 1.35, 2.16, 1.79 and 3.84 for groups 2-5, respectively). Furthermore, a clear stratification was demonstrated for DMFS (aHR 2.03, 3.18, 3.62 and 13.77 for groups 2-5, respectively) and PCSS (aHR 3.00, 5.32, 6.02 and 39.02 for groups 2-5, respectively). The 5-grade group system had improved prognostic discrimination for all end points compared with the commonly used three-tiered system (that is, Gleason score 6, 7 and 8-10). CONCLUSIONS: In a large independent radiotherapy cohort with long-term follow-up, we have validated the bRFS benefit of the proposed five-tier grade grouping system. Furthermore, we have demonstrated that the system is highly prognostic for DMFS and PCSS. Grade group 5 had markedly worse outcomes for all end points, and future work is necessary to improve outcomes in these patients.
BACKGROUND: There has been a recent proposal to change the grading system of prostate cancer into a five-tier grade grouping system. The prognostic impact of this has been demonstrated in regards only to biochemical recurrence-free survival (bRFS) with short follow-up (3 years). METHODS: Between 1990 and 2013, 847 consecutive men were treated with definitive external beam radiation therapy at a single academic center. To validate the new grade grouping system, bRFS, distant metastases-free survival (DMFS) and prostate cancer-specific survival (PCSS) were calculated. Adjusted Kaplan-Meier and multivariable Cox regression analyses were performed to assess the independent impact of the new grade grouping system. Discriminatory analyses were performed to compare the commonly used three-tier Gleason score system (6, 7 and 8-10) to the new system. RESULTS: The median follow-up of our cohort was 88 months. The 5-grade groups independently validated differing risks of bRFS (group 1 as reference; adjusted hazard ratio (aHR) 1.35, 2.16, 1.79 and 3.84 for groups 2-5, respectively). Furthermore, a clear stratification was demonstrated for DMFS (aHR 2.03, 3.18, 3.62 and 13.77 for groups 2-5, respectively) and PCSS (aHR 3.00, 5.32, 6.02 and 39.02 for groups 2-5, respectively). The 5-grade group system had improved prognostic discrimination for all end points compared with the commonly used three-tiered system (that is, Gleason score 6, 7 and 8-10). CONCLUSIONS: In a large independent radiotherapy cohort with long-term follow-up, we have validated the bRFS benefit of the proposed five-tier grade grouping system. Furthermore, we have demonstrated that the system is highly prognostic for DMFS and PCSS. Grade group 5 had markedly worse outcomes for all end points, and future work is necessary to improve outcomes in these patients.
Authors: Liang Cheng; Michael O Koch; Beth E Juliar; Joanne K Daggy; Richard S Foster; Richard Bihrle; Thomas A Gardner Journal: J Clin Oncol Date: 2005-05-01 Impact factor: 44.544
Authors: William Jackson; Daniel A Hamstra; Skyler Johnson; Jessica Zhou; Benjamin Foster; Corey Foster; Darren Li; Yeohan Song; Ganesh S Palapattu; Lakshmi P Kunju; Rohit Mehra; Felix Y Feng Journal: Cancer Date: 2013-07-02 Impact factor: 6.860
Authors: Brandon A Mahal; Vinayak Muralidhar; Yu-Wei Chen; Toni K Choueiri; Karen E Hoffman; Jim C Hu; Christopher J Sweeney; James B Yu; Felix Y Feng; Quoc-Dien Trinh; Paul L Nguyen Journal: BJU Int Date: 2015-08-22 Impact factor: 5.588
Authors: Jonathan I Epstein; Lars Egevad; Mahul B Amin; Brett Delahunt; John R Srigley; Peter A Humphrey Journal: Am J Surg Pathol Date: 2016-02 Impact factor: 6.394
Authors: Jennifer R Stark; Sven Perner; Meir J Stampfer; Jennifer A Sinnott; Stephen Finn; Anna S Eisenstein; Jing Ma; Michelangelo Fiorentino; Tobias Kurth; Massimo Loda; Edward L Giovannucci; Mark A Rubin; Lorelei A Mucci Journal: J Clin Oncol Date: 2009-05-11 Impact factor: 44.544
Authors: Andrew J Stephenson; Peter T Scardino; Michael W Kattan; Thomas M Pisansky; Kevin M Slawin; Eric A Klein; Mitchell S Anscher; Jeff M Michalski; Howard M Sandler; Daniel W Lin; Jeffrey D Forman; Michael J Zelefsky; Larry L Kestin; Claus G Roehrborn; Charles N Catton; Theodore L DeWeese; Stanley L Liauw; Richard K Valicenti; Deborah A Kuban; Alan Pollack Journal: J Clin Oncol Date: 2007-05-20 Impact factor: 44.544
Authors: Daniel E Spratt; Michael J Evans; Brian J Davis; Michael G Doran; Man Xia Lee; Neel Shah; John Wongvipat; Kathryn E Carnazza; George G Klee; William Polkinghorn; Donald J Tindall; Jason S Lewis; Charles L Sawyers Journal: Cancer Res Date: 2015-10-02 Impact factor: 12.701
Authors: Helen Davis Bondarenko; Marc Zanaty; Sabrina S Harmouch; Cristina Negrean; Raisa S Pompe; Daniel Liberman; Naeem Bhojani; Pierre I Karakiewicz; Kevin C Zorn; Assaad El-Hakim Journal: Can Urol Assoc J Date: 2018-06-19 Impact factor: 1.862
Authors: R Mathieu; M Moschini; B Beyer; K M Gust; T Seisen; A Briganti; P Karakiewicz; C Seitz; L Salomon; A de la Taille; M Rouprêt; M Graefen; S F Shariat Journal: Prostate Cancer Prostatic Dis Date: 2017-01-10 Impact factor: 5.554
Authors: Anne Offermann; Silke Hohensteiner; Christiane Kuempers; Julika Ribbat-Idel; Felix Schneider; Finn Becker; Marie Christine Hupe; Stefan Duensing; Axel S Merseburger; Jutta Kirfel; Markus Reischl; Verena Lubczyk; Rainer Kuefer; Sven Perner Journal: Front Med (Lausanne) Date: 2017-09-29
Authors: K R Beckmann; A D Vincent; M E O'Callaghan; P Cohen; S Chang; M Borg; S M Evans; D M Roder; K L Moretti Journal: BMC Cancer Date: 2017-08-10 Impact factor: 4.430