Mairo L Diolombi1, Jonathan I Epstein1,2,3. 1. Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. 2. Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. 3. Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Abstract
OBJECTIVES: To determine the risk of pelvic lymph node (LN) metastases at radical prostatectomy (RP) for Gleason score (GS) ≤7: 3 + 3 = 6 (grade group [GG]1); 3 + 4 = 7 (GG2); 3 + 4 = 7 (GG2) with tertiary pattern 5 (T5); 4 + 3 = 7 (GG3); 4 + 3 = 7 (GG3) with T5, using the 2014 modified Gleason grading system and the novel GG system. MATERIALS AND METHODS: We searched our RP database to indentify cases of GS ≤7 prostate cancer with simultaneous pelvic LN dissection (PLND) in the period between 2005 and 2014. Since 2005, we have graded all glomeruloid and cribriform cancer as Gleason pattern 4 and have graded mucinous adenocarcinoma based on the underlying architectural pattern, consistent with the 2014 modified Gleason grading system. All RPs were embedded in entirety, including the PLND. A total of 7 442 cases were identified, of which 73 had at least one positive LN (+LN). RESULTS: The incidence rates for regional LN metastases at RP for 3 + 3 = 6 (GG1), 3 + 4 = 7 (GG2), 3 + 4 = 7 (GG2) with T5, 4 + 3 = 7 (GG3) and 4 + 3 = 7 (GG3) with T5 were 0, 0.6, 0.4, 4.3 and 6.3%, respectively. There was a statistically significant difference in risk of +LNs at RP between the grade groups, as defined by the novel GG system. There was no statistically significant difference in risk of +LNs at RP for men with 3 + 4 (GG2) vs 3 + 4 (GG2) with T5 and for men with 4 + 3 (GG3) vs 4 + 3 (GG3) with T5. Non-pelvic LN involvement was identified in 0.2% of all RP cases. Two patients with GS 3 + 4 = 7 with <5% pattern 4 experienced LN metastases. CONCLUSION: This study supports our previous finding that men with GS 6 (GG1) at RP have no risk of LN metastases. These findings also support the 2014 revisions to the Gleason grading system where 3 + 3 with T4 (2005 modified grading system) is now considered 3 + 4 (GG2), with a comment on percent pattern 4, because <5% pattern 4 increases the risk of LN metastases. It also supports keeping 3 + 4 (GG2) with T5 (<5% pattern 5) and 4 + 3 (GG3) with T5 with their respective grade groups, with a notation of T5 because the <5% higher grade component did not increase the risk of LN metastases within a given GG. Our findings highlight that 3 + 4 (GG2) and 4 + 3 (GG3), even with a 5% higher grade component, are distinct groups with respect to LN metastases and should not be combined under the umbrella designation of GS 7 as is often the case in the literature with the Gleason grading system.
OBJECTIVES: To determine the risk of pelvic lymph node (LN) metastases at radical prostatectomy (RP) for Gleason score (GS) ≤7: 3 + 3 = 6 (grade group [GG]1); 3 + 4 = 7 (GG2); 3 + 4 = 7 (GG2) with tertiary pattern 5 (T5); 4 + 3 = 7 (GG3); 4 + 3 = 7 (GG3) with T5, using the 2014 modified Gleason grading system and the novel GG system. MATERIALS AND METHODS: We searched our RP database to indentify cases of GS ≤7 prostate cancer with simultaneous pelvic LN dissection (PLND) in the period between 2005 and 2014. Since 2005, we have graded all glomeruloid and cribriform cancer as Gleason pattern 4 and have graded mucinous adenocarcinoma based on the underlying architectural pattern, consistent with the 2014 modified Gleason grading system. All RPs were embedded in entirety, including the PLND. A total of 7 442 cases were identified, of which 73 had at least one positive LN (+LN). RESULTS: The incidence rates for regional LN metastases at RP for 3 + 3 = 6 (GG1), 3 + 4 = 7 (GG2), 3 + 4 = 7 (GG2) with T5, 4 + 3 = 7 (GG3) and 4 + 3 = 7 (GG3) with T5 were 0, 0.6, 0.4, 4.3 and 6.3%, respectively. There was a statistically significant difference in risk of +LNs at RP between the grade groups, as defined by the novel GG system. There was no statistically significant difference in risk of +LNs at RP for men with 3 + 4 (GG2) vs 3 + 4 (GG2) with T5 and for men with 4 + 3 (GG3) vs 4 + 3 (GG3) with T5. Non-pelvic LN involvement was identified in 0.2% of all RP cases. Two patients with GS 3 + 4 = 7 with <5% pattern 4 experienced LN metastases. CONCLUSION: This study supports our previous finding that men with GS 6 (GG1) at RP have no risk of LN metastases. These findings also support the 2014 revisions to the Gleason grading system where 3 + 3 with T4 (2005 modified grading system) is now considered 3 + 4 (GG2), with a comment on percent pattern 4, because <5% pattern 4 increases the risk of LN metastases. It also supports keeping 3 + 4 (GG2) with T5 (<5% pattern 5) and 4 + 3 (GG3) with T5 with their respective grade groups, with a notation of T5 because the <5% higher grade component did not increase the risk of LN metastases within a given GG. Our findings highlight that 3 + 4 (GG2) and 4 + 3 (GG3), even with a 5% higher grade component, are distinct groups with respect to LN metastases and should not be combined under the umbrella designation of GS 7 as is often the case in the literature with the Gleason grading system.
Authors: M Boschheidgen; L Schimmöller; S Doerfler; R Al-Monajjed; J Morawitz; F Ziayee; D Mally; M Quentin; C Arsov; P Albers; G Antoch; T Ullrich Journal: Sci Rep Date: 2022-04-25 Impact factor: 4.996