Differential prognostic impact of different Gleason patterns in grade group 4 in radical prostatectomy specimens. Issue 5 (May 2021)

• Record Type: Journal Article
• Authors: Mori, Keiichiro; Sharma, Vidit; Comperat, Eva M.; Sato, Shun; Laukhtina, Ekaterina; Schuettfort, Victor M.; Pradere, Benjamin; Parizi, Mehdi Kardoust; Karakiewicz, Pierre I.; Egawa, Shin; Tilki, Derya; Boorjian, Stephen A.; Shariat, Shahrokh F.
• Is Part Of: European journal of surgical oncology. Volume 47:Issue 5(2021)
• Page Start: 1172
• Page End: 1178
• Publication Date: 2021-05
• Subjects: Prostate cancer -- High risk -- Prostatectomy -- Grade group -- Gleason score; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2020.12.014
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: There are questions regarding whether grade group (GG) 4 prostate cancer (PC) is heterogeneous in terms of prognosis. We assessed prognostic differences in PC patients within GG 4 treated with radical prostatectomy (RP). Material and methods: Biochemical recurrence (BCR)-free, cancer-specific, and overall survival were analyzed in 787 PC patients with GG 4 based on RP pathology (Gleason score (GS) 3 + 5: 189, GS 4 + 4: 500, and GS 5 + 3: 98). Logistic regression analysis was performed to assess factors predictive of high-risk surgical pathological features. Cox regression models were used to evaluate potential prognostic factors of survival. Results: Within a median follow-up of 86 months, 378 patients (48.0%) experienced BCR and 96 patients (12.2%) died, 42 of whom (5.3%) died of PC. GS 5 + 3 was significantly associated with worse BCR-free and cancer-specific survival, as well as higher positive surgical margin, lymph node metastasis, extraprostatic extension, and non-organ-confined disease rates, than GS 3 + 5 and higher positive surgical margin, lymph node metastasis, extraprostatic extension, and non-organ-confined disease rates than GS 4 + 4 ( P < 0.05). GS 4 + 4 was significantly associated with worse BCR-free survival and higher extraprostatic extension, and non-organ-confined disease rates than GS 3 + 5 ( P < 0.05). Inclusion of the different Gleason patterns improved the discrimination of a model for prediction of all survival outcomes compared to standard prognosticators. Conclusions: There is considerable heterogeneity within GG 4 in terms of oncological and surgical pathological outcomes. Primary and secondary Gleason patterns should be considered to stratify high-risk PC patients after RP.