A Multi-Institutional Validation of Gleason Score Derived from Tissue Microarray Cores
To test the agreement between high-grade PCa at RP and TMA, and the ability of TMA to predict BCR. Validation of concordance between tissue microarray (TMA) and radical prostatectomy (RP) high-grade prostate cancer (PCa) is crucial because latter determines the treated natural history of PCa. We hypothesized that TMA Gleason score is in agreement with RP pathology and capable of accurately predicting biochemical recurrence (BCR). Data were provided from a multi-institutional Canadian sample of 1333 TMA and RP specimens with complete clinicopathological data. First, rate of agreement between TMA and high-grade Gleason at RP or biopsy and RP was tested. Second, ability of RP, TMA and biopsy to predict BCR was compared. Multivariable (MVA) Cox regression models were fitted and BCR rates were illustrated with Kaplan-Meier plots. Agreement between RP and TMA and between RP and biopsy was 72.6% (95% CI:69.7–75.5) and 60.4% (95% CI:57.2–63.6), respectively. In MVA predicting BCR, the accuracy for RP, TMA and biopsy was 0.73, 0.72 and 0.68, respectively. TMA added discriminatory ability among exclusively low-grade Gleason RP patients (p = 0.02), but did not improve BCR discrimination in exclusive high-grade PCa RP patients (p = 0.8). TMA Gleason grade accurately reflects presence of high-grade Gleason in RP specimen, accurately predicts BCR rates after RP and improves prediction of BCR in low-grade Gleason patients at RP.
KeywordsRadical prostatectomy Prostate cancer Gleason grade agreement Biochemical recurrence Validation
The Network acknowledges contributions to its CPCBN biobank from several Institutions across Canada, namely Centre hospitalier de l’Université de Montreal (CHUM), Centre hospitalier universitaire de Quebec (CHUQ), McGill University Health Centre (MUHC), University Health Network (UHN), University of British Columbia/Vancouver Coastal Health Authority.
All authors of this research paper have directly participated in the planning, execution, or analysis of the study. All authors of this paper have read and approved the final version submitted. The authors listed below have made substantial contributions to the intellectual content of the paper in the various sections described below:
SR Leyh-Bannurah: data analysis, data management, manuscript writing.
D Trudel: data analysis, protocol development, manuscript writing.
M Latour: project development, manuscript editing.
E Zaffuto: manuscript editing, data analysis.
AA Grosset: manuscript editing, data collection.
C Tam: protocol development, project development, data collection.
V Ouellet: protocol development, project development, manuscript editing.
M Graefen: manuscript editing, data analysis.
L Budäus: manuscript editing, manuscript editing.
A Aprikian: project development, data analysis.
L Lacombe: project development, data analysis.
N Fleshner: data analysis, protocol development, manuscript editing.
ME Gleave: protocol development, data collection.
AM Mes-Masson: protocol development, data collection.
F Saad: project development, data collection, data management, manuscript editing.
PI Karakiewicz: project development, data analysis, manuscript writing, manuscript editing.
Compliance with Ethical Standards
Conflict of Interest
There are no conflicts of interest. The contents of this manuscript have not been copyrighted or published previously. The contents of this manuscript are not under consideration for publication elsewhere.
Informed written consent was obtained and ethical standards were adhered to.
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