Abstract
Purpose
To evaluate the ability of the new Gleason grade groups (GGGs) to stratify risk in prostate cancer patients with locally adverse pathologic features after radical prostatectomy (RP) thereby allowing more accurate assessment for planning eventual adjuvant therapy.
Patients and methods
Data on 172 patients with locally adverse pathologic features (including seminal vesicle invasion, extracapsular extension, or positive surgical margins) who had been treated with wait and see policy after RP were retrospectively analyzed for biochemical recurrence (BCR)-free survival. Kaplan–Meier survival analysis and Cox proportional hazard regression models were used to test the association between the GGGs and BCR. Finally, concordance indices of different grading classifications were calculated to evaluate the predictive accuracy for biochemical failure after RP.
Results
The five-year BCR-free survival rates were 71.2, 66.9, 25.7, 17.4, and 8.3 % for GGG 1–5 assessed on surgical specimens (p < 0.001, log-rank test). In the two-way log-rank test, men with prostatectomy GGG 2 had a lower progression risk relative to GGG 3 (p = 0.001), though similar risk as GGG 1 (p = 0.105). In multivariate Cox regression analysis, specimen GGG ≥3 and early postoperative PSA ≥0.1 ng/ml were independent risk factors for biochemical failure (p < 0.001). In addition, GGGs had higher predictive accuracy compared with the alternate classification system (improvement in concordance index by 0.036–0.141).
Conclusions
For the appropriate patient, depending on age, physical condition, early postoperative PSA, patient desire, etc., could be a candidate for wait and see policy with specimen GGG 2 disease, so to distinguish this from GGG 3 may facilitate discussions at the point of treatment decision making.
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Acknowledgments
This study was supported by National Natural Science Foundation of China (91129725, 81572536), Science and Technology Commission of Shanghai Municipality (14140901700), Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support (20152215), and the Key Disciplines Group Construction Project of Pudong Health Bureau of Shanghai (PWZxq2014-05). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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This study was approved by the Ethics Committee at the Renji Hospital, Shanghai Jiao Tong University School of Medicine. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Xun Shangguan, Baijun Dong and Yanqing Wang have contributed equally to this work.
Jiahua Pan and Wei Xue co-supervised this work.
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Shangguan, X., Dong, B., Wang, Y. et al. Management of prostate cancer patients with locally adverse pathologic features after radical prostatectomy: feasibility of active surveillance for cases with Gleason grade 3 + 4 = 7. J Cancer Res Clin Oncol 143, 123–129 (2017). https://doi.org/10.1007/s00432-016-2262-9
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DOI: https://doi.org/10.1007/s00432-016-2262-9