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Differential prognostic impact of different Gleason patterns in grade group 4 in radical prostatectomy specimens

2020; Elsevier BV; Volume: 47; Issue: 5 Linguagem: Inglês

10.1016/j.ejso.2020.12.014

1532-2157

Keiichiro Mori, Vidit Sharma, Éva Compérat, Shun Sato, Ekaterina Laukhtina, Victor M. Schuettfort, Benjamin Pradère, Mehdi Kardoust Parizi, Pierre I. Karakiewicz, Shin Egawa, Derya Tilki, Stephen A. Boorjian, Shahrokh F. Shariat,

Urologic and reproductive health conditions

IntroductionThere 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 methodsBiochemical 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.ResultsWithin 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.ConclusionsThere 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.