Size-adjusted Quantitative Gleason Score as a Predictor of Biochemical Recurrence after Radical Prostatectomy

Fang-Ming Deng; Nicholas M Donin; Ruth Pe Benito; Jonathan Melamed; Julien Le Nobin; Ming Zhou; Sisi Ma; Jinhua Wang; Herbert Lepor

doi:10.1016/j.eururo.2015.10.026

Size-adjusted Quantitative Gleason Score as a Predictor of Biochemical Recurrence after Radical Prostatectomy

Eur Urol. 2016 Aug;70(2):248-53. doi: 10.1016/j.eururo.2015.10.026. Epub 2015 Oct 30.

Authors

Fang-Ming Deng¹, Nicholas M Donin², Ruth Pe Benito¹, Jonathan Melamed¹, Julien Le Nobin³, Ming Zhou⁴, Sisi Ma⁵, Jinhua Wang⁶, Herbert Lepor³

Affiliations

¹ Department of Pathology, New York University School of Medicine, New York, NY, USA.
² Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. Electronic address: ndonin@mednet.ucla.edu.
³ Department of Urology, New York University School of Medicine, New York, NY, USA.
⁴ Department of Pathology, New York University School of Medicine, New York, NY, USA; Department of Urology, New York University School of Medicine, New York, NY, USA.
⁵ Center for Health Informatics and Bioinformatics, New York University School of Medicine, New York, NY, USA.
⁶ Center for Health Informatics and Bioinformatics, New York University School of Medicine, New York, NY, USA; NYU Cancer Institute, New York University School of Medicine, New York, NY, USA.

Abstract

Background: The risk of biochemical recurrence (BCR) following radical prostatectomy for pathologic Gleason 7 prostate cancer varies according to the proportion of Gleason 4 component.

Objective: We sought to explore the value of several novel quantitative metrics of Gleason 4 disease for the prediction of BCR in men with Gleason 7 disease.

Design, setting, and participants: We analyzed a cohort of 2630 radical prostatectomy cases from 1990-2007. All pathologic Gleason 7 cases were identified and assessed for quantity of Gleason pattern 4. Three methods were used to quantify the extent of Gleason 4: a quantitative Gleason score (qGS) based on the proportion of tumor composed of Gleason pattern 4, a size-weighted score (swGS) incorporating the overall quantity of Gleason 4, and a size index (siGS) incorporating the quantity of Gleason 4 based on the index lesion.

Outcome measurements and statistical analysis: Associations between the above metrics and BCR were evaluated using Cox proportional hazards regression analysis.

Results and limitations: qGS, swGS, and siGS were significantly associated with BCR on multivariate analysis when adjusted for traditional Gleason score, age, prostate specific antigen, surgical margin, and stage. Using Harrell's c-index to compare the scoring systems, qGS (0.83), swGS (0.84), and siGS (0.84) all performed better than the traditional Gleason score (0.82).

Conclusions: Quantitative measures of Gleason pattern 4 predict BCR better than the traditional Gleason score.

Patient summary: In men with Gleason 7 prostate cancer, quantitative analysis of the proportion of Gleason pattern 4 (quantitative Gleason score), as well as size-weighted measurement of Gleason 4 (size-weighted Gleason score), and a size-weighted measurement of Gleason 4 based on the largest tumor nodule significantly improve the predicted risk of biochemical recurrence compared with the traditional Gleason score.

Keywords: Gleason score; Humans; Neoplasm grading; Neoplasm recurrence; Prognosis; Prostatectomy; Prostatic neoplasms; Risk assessment; Tumor volume.

MeSH terms

Aged
Humans
Male
Middle Aged
Neoplasm Grading / methods
Outcome Assessment, Health Care
Prostate / pathology*
Prostate-Specific Antigen / analysis
Prostatectomy* / adverse effects
Prostatectomy* / methods
Prostatic Neoplasms* / pathology
Prostatic Neoplasms* / surgery
Recurrence
Risk Assessment / methods
Tumor Burden

Substances

Prostate-Specific Antigen

Abstract

MeSH terms

Substances

Grants and funding