Judith Grogan1, Ruta Gupta1,2,3, Kate L Mahon1,4, Phillip D Stricker5, Anne-Maree Haynes1, Warick Delprado6,7, Jennifer Turner6,7, Lisa G Horvath1,3,4, James G Kench1,2,3. 1. Cancer Research Program, Kinghorn Cancer Centre/Garvan Institute of Medical Research, Darlinghurst, NSW, Australia. 2. Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. 3. Sydney Medical School, University of Sydney, Sydney, NSW, Australia. 4. Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia. 5. Department of Urology, St Vincent's Hospital, Sydney, NSW, Australia. 6. Douglass Hanly Moir Pathology, Sydney, NSW, Australia. 7. Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
Abstract
OBJECTIVE: To assess the relationship between the International Society of Urological Pathology (ISUP) 2014 grading system, biochemical recurrence (BCR) and clinical recurrence (CLR) after radical prostatectomy (RP), to determine whether the 2014 ISUP grading system is a better predictor of survival compared with the previous Gleason scoring systems, and to investigate whether incorporation of the tertiary pattern/grade into the ISUP scoring system significantly improves its efficacy. PATIENTS AND METHODS: A total of 635 RP cases (1991-1999) were identified from a database at a single institution. A histopathology review was performed to re-grade the cases as per the ISUP 2014 grading system. All relevant clinicopathological data and clinical follow-up (median [range] 15.25 [0.3-26] years) were obtained. Log-rank, Kaplan-Meier, Cox regression and Harrell's concordance c-indices analyses were performed. RESULTS: At a median follow-up of 15 years, 276 patients (44%) had BCR and 41 (7%) had CLR. Grade Groups 1, 2, 3, 4 and 5 were seen in 112 (18%), 307 (48%), 129 (20%), 33 (5%) and 54 patients (9%), respectively: 337 (53%) were upgraded, while 70 (11%) were downgraded compared with the 1992 Gleason system. Grade Group (hazard ratio [HR] 4.9; P < 0.001) and preoperative prostate-specific antigen (PSA) level (HR 1.4; P < 0.001) were independent predictors of BCR. Only Grade Group 5 (HR 12.3; P = 0.02), preoperative PSA (HR 1.6; P < 0.001), stage pT3b (HR 3.1; P = 0.03) and pT4 (HR 12.4; P < 0.001) independently predicted CLR. Harrell's c-indices showed that the 2014 ISUP grading system was a significantly better predictor of BCR and CLR as well as prostate cancer-specific death, compared with the 2005 ISUP modified Gleason system. The replacement of the secondary pattern by the tertiary pattern did not alter the prognostic efficacy of the ISUP 2014 grading system. CONCLUSIONS: The ISUP 2014 grading system is a significant independent predictor of both BCR and CLR, outperforming the 2005 ISUP modified Gleason system. This classification system has the potential to influence clinical decision-making after RP.
OBJECTIVE: To assess the relationship between the International Society of Urological Pathology (ISUP) 2014 grading system, biochemical recurrence (BCR) and clinical recurrence (CLR) after radical prostatectomy (RP), to determine whether the 2014 ISUP grading system is a better predictor of survival compared with the previous Gleason scoring systems, and to investigate whether incorporation of the tertiary pattern/grade into the ISUP scoring system significantly improves its efficacy. PATIENTS AND METHODS: A total of 635 RP cases (1991-1999) were identified from a database at a single institution. A histopathology review was performed to re-grade the cases as per the ISUP 2014 grading system. All relevant clinicopathological data and clinical follow-up (median [range] 15.25 [0.3-26] years) were obtained. Log-rank, Kaplan-Meier, Cox regression and Harrell's concordance c-indices analyses were performed. RESULTS: At a median follow-up of 15 years, 276 patients (44%) had BCR and 41 (7%) had CLR. Grade Groups 1, 2, 3, 4 and 5 were seen in 112 (18%), 307 (48%), 129 (20%), 33 (5%) and 54 patients (9%), respectively: 337 (53%) were upgraded, while 70 (11%) were downgraded compared with the 1992 Gleason system. Grade Group (hazard ratio [HR] 4.9; P < 0.001) and preoperative prostate-specific antigen (PSA) level (HR 1.4; P < 0.001) were independent predictors of BCR. Only Grade Group 5 (HR 12.3; P = 0.02), preoperative PSA (HR 1.6; P < 0.001), stage pT3b (HR 3.1; P = 0.03) and pT4 (HR 12.4; P < 0.001) independently predicted CLR. Harrell's c-indices showed that the 2014 ISUP grading system was a significantly better predictor of BCR and CLR as well as prostate cancer-specific death, compared with the 2005 ISUP modified Gleason system. The replacement of the secondary pattern by the tertiary pattern did not alter the prognostic efficacy of the ISUP 2014 grading system. CONCLUSIONS: The ISUP 2014 grading system is a significant independent predictor of both BCR and CLR, outperforming the 2005 ISUP modified Gleason system. This classification system has the potential to influence clinical decision-making after RP.
Authors: David R Thurtle; David C Greenberg; Lui S Lee; Hong H Huang; Paul D Pharoah; Vincent J Gnanapragasam Journal: PLoS Med Date: 2019-03-12 Impact factor: 11.069
Authors: Ruth Pidsley; Dilys Lam; Wenjia Qu; Timothy J Peters; Phuc-Loi Luu; Darren Korbie; Clare Stirzaker; Roger J Daly; Phillip Stricker; James G Kench; Lisa G Horvath; Susan J Clark Journal: Clin Transl Med Date: 2022-10
Authors: Justin G Mygatt; Jennifer Cullen; Samantha A Streicher; Huai-Ching Kuo; Yongmei Chen; Denise Young; William Gesztes; Grant Williams; Galen Conti; Christopher Porter; Sean P Stroup; Kevin R Rice; Inger L Rosner; Allen Burke; Isabell Sesterhenn Journal: Cancer Med Date: 2020-01-21 Impact factor: 4.452
Authors: Lars Egevad; Daniela Swanberg; Brett Delahunt; Peter Ström; Kimmo Kartasalo; Henrik Olsson; Dan M Berney; David G Bostwick; Andrew J Evans; Peter A Humphrey; Kenneth A Iczkowski; James G Kench; Glen Kristiansen; Katia R M Leite; Jesse K McKenney; Jon Oxley; Chin-Chen Pan; Hemamali Samaratunga; John R Srigley; Hiroyuki Takahashi; Toyonori Tsuzuki; Theo van der Kwast; Murali Varma; Ming Zhou; Mark Clements; Martin Eklund Journal: Virchows Arch Date: 2020-06-15 Impact factor: 4.064
Authors: Lars Egevad; Brett Delahunt; David G Bostwick; Liang Cheng; Andrew J Evans; Troy Gianduzzo; Markus Graefen; Jonas Hugosson; James G Kench; Katia R M Leite; Jon Oxley; Guido Sauter; John R Srigley; Pär Stattin; Toyonori Tsuzuki; John Yaxley; Hemamali Samaratunga Journal: BJU Int Date: 2020-11-27 Impact factor: 5.588