Comparison of Gleason scoring and the new Grade-Group System in prostate cancers: a 15-year retrospective study

Yıl 2020, Cilt: 3 Sayı: 4, 382 - 388, 22.10.2020

Mehmet Zengın , Merve Eryol , Merva Aydemir Akkaya , Mahi Balcı , Selim Yalçın , Devrim Tuğlu

https://doi.org/10.32322/jhsm.758558

Öz

Aim: Prostate cancer (PC) is the most common malignant tumour in men. The most widely used histological grading scheme for PC is Gleason scoring (GS). After the original, this system has been modified several times. In this study, we retrospectively investigated the new Grade-Group system (GGS).
Methods: This study includes 486 cases diagnosed with PC between 2000 and 2015. All cases were re-grouped for the new GGS system and its relationship with prognosis was examined.
Results: GGS subgroups had a statistically significant relationship between prognostic factors and this relationship was more significant between GGS 2 and GGS 3 [tumor status (p <0.001), age (p = 0.045), PN invasion (p <0.001), stage (p = 0.004), and LN status (p <0.001)]. In univariable survival analysis, there was a significant difference between GGS subgroups (for GGS 2-GGS 3, RFS: p = 0.035 and OS: p = 0.012; for GGS 4-GGS 5, RFS: p = 0.001 and OS: p = 0.001). In multivariable survival analysis, GGS subgroups were found to be an independent survival parameter for PC (for GGS 2-GGS 3, OS: HR = 2.56, p = 0.012 and RFS: HR = 2.69, p = 0.038; for GGS 4-GGS 5, OS: HR = 2.84, p = 0.011 and RFS: HR = 2.59, p < 0.001).
Conclusions: According to our results, the new GGS performs the prognostic risk grading more accurately than the old classification. Also, the fact that this system contains fewer categories and is simpler has increased the interobserver compatibility.
Keywords: Grade-group system, Gleason scoring, prostate cancer.

ÖZ
Amaç: Prostat kanseri (PK) erkeklerde en sık görülen malign tümördür. PK için en yaygın kullanılan histolojik derecelendirme şeması Gleason skorlamasıdır (GS). Orijinalinden sonra bu sistem birkaç kez değiştirildi. Bu çalışmada, PK için tanımlanan yeni Grade-Group sistemini (GGS) geriye dönük olarak inceledik.
Yöntemler: Bu çalışma 2000-2015 yılları arasında PK tanısı konmuş 486 vakayı içermektedir. Tüm olgular yeni GGS sistemi için yeniden gruplandırıldı ve prognozla ilişkisi incelendi.
Bulgular: GGS alt gruplarının prognostik faktörler arasında istatistiksel olarak anlamlı bir ilişki vardı ve bu ilişki GGS 2 ve GGS 3 arasında daha anlamlı idi [tümör durumu (p <0.001), yaş (p = 0.045), PN invazyonu (p <0.001), evre (p = 0.004), ve LN durumu (p <0.001)]. Tek değişkenli sağkalım analizinde GGS alt grupları arasında anlamlı bir fark vardı (GGS 2-GGS 3, RFS: p = 0.035 ve OS: p = 0.012; GGS 4-GGS 5, RFS için: p = 0.001 ve OS: p = 0.001). Çok değişkenli sağkalım analizinde GGS alt gruplarının PK için bağımsız bir sağkalım parametresi olduğu bulundu (GGS 2-GGS 3, OS: HR = 2.56, p = 0.012 ve RFS: HR = 2.69, p = 0.038; GGS 4- için GGS 5, OS: HR = 2.84, p = 0.011 ve RFS: HR = 2.59, p <0.001).
Sonuçlar: Çalışmamıza göre, yeni GGS sistemi prognostik risk sınıflandırmasını eski sınıflandırmadan daha doğru bir şekilde gerçekleştirmektedir. Ayrıca, bu sistemin daha az kategori içermesi ve daha basit olması, gözlemciler arası uyumluluğu artırdı.
Anahtar Kelimeler: Grade-grup sistemi, gleason skorlaması, prostat kanseri.

Anahtar Kelimeler

Grade-group system, Gleason scoring, prostate cancer

Kaynakça

• Siegel RL, Miller KD, Jemal A.Cancer statistics, 2017. CA Cancer J Clin 2017; 67: 7-30.
• Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016; 66: 271-89.
• Epstein JI, Egevad L, AminMB, et al. The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol 2016; 40: 244-52.
• Mellinger GT, Gleason D, Bailar J. The histology and prognosis of prostatic cancer. J Urol 1967; 97: 331– 7.
• Gleason DF, Mellinger GT. Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. J Urol 1974; 111: 58–64.
• Epstein JI, Allsbrook WC, Amin MB, et al. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol 2005; 29: 1228–42.
• Pierorazio PM, Walsh PC, Partin AW, Epstein JI. Prognostic Gleason grade grouping: Data based on the modified Gleason scoring system. BJU Int 2013; 111: 753–60.
• Hamdy FC, Donovan JL, Lane JA,et al. ProtecT Study Group. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer.N Engl J Med 2016; 375: 1415-24.
• Barocas DA, Alvarez J, Resnick MJ, et al. Association between radiation therapy, surgery, or observation for localized prostate cancer and patient-reported outcomes after 3 years. JAMA 2017; 317: 1126-40.
• Ozok HU, Sagnak L, Tuygun C, et al. Will the modification of the Gleason grading system affect the urology practice? Int J Surg Pathol 2010; 18: 248–54.
• Alenda O, Ploussard G, Mouracade P, et al. Impact of the primary Gleason pattern on biochemical recurrence‐free survival after radical prostatectomy: a single‐center cohort of 1.248 patients with Gleason 7 tumors. World J Urol 2010; 29: 671–6.
• Billis A, Guimaraes MS, Freitas LL, et  al. The impact of the 2005 international society of urological pathology consensus conference on standard Gleason grading of prostatic carcinoma in needle biopsies. J Urol 2008; 180: 548–52.
• Helpap B, Egevad L. The significance of modified Gleason grading of prostatic carcinoma in biopsy and radical prostatectomy specimens. Virchows Arch 2006; 449: 622–7.
• Tsivian M, Sun L, Mouraviev V, et al. Changes in Gleason score grading and their effect in predicting outcome after radical prostatectomy. Urology2009; 74: 1090–3.
• Trock BJ, Guo CC, Gonzalgo ML, et al. Tertiary Gleason patterns and biochemical recurrence after prostatectomy: proposal for a modified Gleason scoring system. J Urol 2009; 182: 1364–70.
• Pan CC, Potter SR, Partin AW, et al. The prognostic significance of tertiary Gleason patterns of higher grade in radical prostatectomy specimens: a proposal to modify the Gleason grading system. Am J Surg Pathol 2000; 24: 563–9.
• AminA, Partin A, Epstein JI. Gleason score 7 prostate cancer on needle biopsy: relation of primary pattern 3 or 4 to pathological stage and progression after radical prostatectomy. J Urol 2011; 186: 1286–90.
• Wright JL, Salinas CA, Lin DW, et al. Prostate cancer specific mortality and Gleason 7 disease differences in prostate cancer outcomes between cases with Gleason 4+3 and Gleason 3+4 tumours in a population based cohort. J Urol 2009; 182: 2702–7.
• Rasiah KK, Stricker PD, Haynes AM, et al. Prognostic significance of Gleason pattern in patients with Gleason score 7 prostate carcinoma. Cancer 2003; 98: 2560–5.
• Mosse CA, Magi‐Galluzzi C, Tsuzuki T, et al. The prognostic significance of tertiary Gleason pattern 5 in radical prostatectomy specimens. Am J Surg Pathol 2004; 28: 394–8.
• Whittemore DE, Hick EJ, Carter MR, et al. Significance of tertiary Gleason pattern 5 in Gleason score 7 radical prostatectomy specimens. J Urol 2008; 179: 516–22.
• Sabolch A, Feng FY, Daignault‐Newton S, et al. Gleason pattern 5 is the greatest risk factor for clinical failure and death from prostate cancer after dose‐escalated radiation therapy and hormonal ablation. Int J Radiat Oncol Biol Phys 2011; 81: 351–60.