Predictive value of the UICC and AJCC 8th edition tumor-nodes-metastasis (TNM) classification for patients treated with radical prostatectomy

According to the 8th-edition of the tumor-nodes-metastasis-classification localized prostate cancer (PCa) can be divided into two categories (cT1,cT2), two stages (SI,SII), and, by incorporating prostate-specific-antigen (PSA) and WHO-grade (Gleason-Score), into prognostic stage groups (PSG I,IIA,IIB,IIC,III). We examined the predictive value of these systems for an organ-confined disease (pT≤2), favorable WHO-grade ≤2 (Gleason-score ≤7a), and biochemical-free-survival (BFS) after radical prostatectomy (RP).

Data were collected in a prospective, non-interventional, multicenter health-service-research study for the treatment of localized PCa (HAROW) with 687 patients receiving RP. Mean Follow-up was 31.7 months.

Organ-confined disease was present in 76.5% and 63.6% of cT1 and cT2 patients, 75.7% and 59.6% of SI and SII, and 84.6%, 81.6%, 72.8% and 42.5% of PSG I, IIA, IIB and ≥ IIC (p = 0.001). Favorable WHO-grade (Gleason-Score) was present in 75.4% and 60.7% of cT1 and cT2 patients, 74.3% and 56.5% of SI and SII patients, and 86.1%,85.6%,73.3% and 29.5% of PSG I, IIA, IIB and ≥ IIC (p = 0.001). Probability of BFS was 92.0% and 91.5% for cT1 and cT2 (p = 0.990), 91.1% and 94.2% for SI and S II (p = 0.286) and 96.6%,95.1%,91.4% and 78.8% for PSG I,IIA,IIB and ≥ IIC (p = 0.001).

CT 1/cT2 and S I/II subgrouping is feasible to predict a different pT-category and a favorable WHO-grade (Gleason-Score) after RP, but failed to predict a different BFS. With the additional information of WHO-grade (Gleason-Score) and PSA, the PSG represents an approach for the prediction of all examined endpoints which is a useful tool to help clinicians to advise their patients.

Cancer epidemiology. 2018 Aug 31 [Epub ahead of print]

Jan Herden, Axel Heidenreich, Christian Wittekind, Lothar Weissbach

Department of Urology, University Hospital Cologne, Cologne, Germany. Electronic address: ., Department of Urology, University Hospital Cologne, Cologne, Germany., Institute of Pathology, University Hospital Leipzig, Leipzig, Germany., Health Research for Men GmbH, Berlin, Germany.

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