To evaluate the International Society of Urological Pathology (ISUP) 5-tier grade grouping (GG) system of prostate cancers as well as previously proposed optimizations.
The PROCURE biobank is a prospective cohort study of patients with localized prostate cancer who underwent radical prostatectomy in Quebec province between 2005 and 2013. Surgical specimens were graded by experienced genitourinary pathologists using 2019 ISUP criteria. Follow-up was conducted until November 2021. The current 5-tier and a proposed 6-tier GG system were evaluated, the latter having two changes: 1) Gleason 3+4 and 4+3 tumors with minor/tertiary Gleason 5 patterns were upgraded to GG 3 and 4, respectively; and 2) patients in GG5 were separated based on primary Gleason pattern (4 or 5). Cox proportional hazards models and Harrell's concordance (C) indices were used for statistical analyses.
2003 patients were included (median follow-up: 8.7 years). The current 5-tier GG system predicted time to recurrence (hazard ratio [HR] 2.12, 95% confidence interval [95%CI] 1.99-2.25, C 0.717), androgen-deprivation therapy (HR 2.58, 95%CI 2.38-2.80, C 0.790), metastasis (HR 2.48, 95%CI 2.17-2.83, C 0.806), castration-resistant prostate cancer (HR 2.67, 95%CI 2.28-3.13, C 0.829), and cancer-specific mortality (HR 2.80, 95%CI 2.27-3.44, C 0.835). Goodness-of-fit further improved with the proposed 6-tier GG system, with Harrell's C of 0.733, 0.807, 0.827, 0.853, and 0.853, respectively.
The 5-tier GG system predicted short- and long-term outcomes for patients with localized prostate cancer, and the proposed 6-tier GG system further improved its accuracy.
Human pathology. 2024 Apr 10 [Epub ahead of print]
Michel Wissing, Fadi Brimo, Ginette McKercher, Eleonora Scarlata, Fred Saad, Michel Carmel, Louis Lacombe, Bernard Têtu, Nadia Ekindi-Ndongo, Mathieu Latour, Dominique Trudel, Simone Chevalier, Armen Aprikian
Department of Surgery, McGill University Health Centre, 1001 Boulevard Décarie, Montreal, QC H4A 3J1, Canada; Department of Oncology, McGill University, 5100 Blvd de Maisonneuve Ouest, bureau 720, Montreal, QC H4A 3T2, Canada. Electronic address: ., Department of Pathology, McGill University Health Centre, 1001 Boulevard Décarie, Montreal, QC H4A 3J1, Canada. Electronic address: ., Department of Surgery, McGill University Health Centre, 1001 Boulevard Décarie, Montreal, QC H4A 3J1, Canada. Electronic address: ., Department of Surgery, McGill University Health Centre, 1001 Boulevard Décarie, Montreal, QC H4A 3J1, Canada. Electronic address: ., Department of Surgery, Université de Montréal, C.P. 6128, succursale Centre-ville, Montreal, QC H3C 3J7, Canada. Electronic address: ., Department of Surgery, Université de Sherbrooke, 3001, 12e avenue Nord, Sherbrooke, QC J1H 5N4, Canada. Electronic address: ., Department of Surgery, Laval University, 1050 Av. de la Médecine, Quebec City, QC G1V 0A6, Canada. Electronic address: ., Department of Pathology, Laval University, 1050 Av. de la Médecine, Quebec City, QC G1V 0A6, Canada. Electronic address: ., Department of Pathology, Université de Sherbrooke, 3001, 12e avenue Nord, Sherbrooke, QC J1H 5N4, Canada. Electronic address: ., Department of Pathology and Cell Biology, Université de Montréal, C.P. 6128, succursale Centre-ville, Montreal, QC H3C 3J7, Canada. Electronic address: ., Department of Pathology and Cell Biology, Université de Montréal, C.P. 6128, succursale Centre-ville, Montreal, QC H3C 3J7, Canada. Electronic address: ., Department of Surgery, McGill University Health Centre, 1001 Boulevard Décarie, Montreal, QC H4A 3J1, Canada; Department of Oncology, McGill University, 5100 Blvd de Maisonneuve Ouest, bureau 720, Montreal, QC H4A 3T2, Canada. Electronic address: ., Department of Surgery, McGill University Health Centre, 1001 Boulevard Décarie, Montreal, QC H4A 3J1, Canada; Department of Oncology, McGill University, 5100 Blvd de Maisonneuve Ouest, bureau 720, Montreal, QC H4A 3T2, Canada. Electronic address: .