A systematic review and meta-analysis of prognostic impact of different Gleason patterns in ISUP grade group 4

Mori, Keiichiro; Miura, Noriyoshi; Compérat, Éva; Nikles, Sven; Pang, Karl H.; Misraï, Vincent; Rivas, Juan Gómez; Papalia, Rocco; Shariat, Shahrokh F.; Esperto, Francesco; Pradère, Benjamin

doi:10.23736/s2724-6051.20.03778-9

Cited by 4 publications

(4 citation statements)

References 28 publications

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“… 7 , 8 Moreover, given that Gleason pattern 5 has a negative prognostic significance compared with pattern 4, there is concern that GG 4 is subject to heterogeneity with respect to oncological outcomes. 9 – 11 An updated meta-analysis of different GS patterns of PC in GG 4 showed that GS 4 + 4 was associated with better overall survival (OS); 12 however, this meta-analysis had significant heterogeneity in the population of interest, mainly because it did not restrict the interventions implemented. Moreover, it made no distinction between GG 4 on biopsy and radical prostatectomy (RP) specimens.…”

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confidence: 99%

Prognostic Impact of Different Gleason Patterns on Biopsy Within Grade Group 4 Prostate Cancer

Mori

Compérat

et al. 2021

Ann Surg Oncol

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Background Grade group (GG) 4 prostate cancer (PC) is considered a single entity; however, there are questions regarding prognostic heterogeneity. This study assessed the prognostic differences among various Gleason scores (GSs) classified as GG 4 PC on biopsy before radical prostatectomy (RP). Methods We conducted a multicenter retrospective study, and a total of 1791 patients (GS 3 + 5: 190; GS 4 + 4: 1557; and GS 5 + 3: 44) with biopsy GG 4 were included for analysis. Biochemical recurrence (BCR)-free survival, cancer-specific survival, and overall survival were analyzed using the Kaplan–Meier method and the log-rank test. Logistic regression analysis was performed to identify factors associated with high-risk surgical pathologic features. Cox regression models were used to analyze time-dependent oncologic endpoints. Results Over a median follow-up of 75 months, 750 patients (41.9%) experienced BCR, 146 (8.2%) died of any causes, and 57 (3.2%) died of PC. Biopsy GS 5 + 3 was associated with significantly higher rates of GS upgrading in RP specimens than GS 3 + 5 and GS 4 + 4. On multivariable analysis adjusted for clinicopathologic features, different GSs within GG 4 were significantly associated with BCR (p = 0.03) but not PC-specific or all-cause mortality. Study limitations include the lack of central pathological specimen evaluation. Conclusions Patients with GG 4 at biopsy exhibited some limited biological and clinical heterogeneity. Specifically, GS 5 + 3 had an increased risk of GS upgrading. This can help individualize patients’ counseling and encourage further study to refine biopsy specimen-based GG classification.

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confidence: 99%

Prognostic Impact of Different Gleason Patterns on Biopsy Within Grade Group 4 Prostate Cancer

Mori

Compérat

et al. 2021

Ann Surg Oncol

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“… 8 Additionally, oncological outcomes have been evaluated among localized or metastatic PCa patients within GG 4 treated with RP, radiotherapy (RT) and androgen deprivation therapy (ADT). 8 However, the impact of the GG 4 subgroups on oncological outcomes has never been investigated in Japanese PCa patients undergoing RARP. The ability to predict which patients are more likely to develop BCR after RARP could be helpful when choosing the best treatment strategy.…”

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confidence: 99%

“…GS 3 + 5, GS 4 + 4 and GS 5 + 3), regardless of their primary and secondary scores. A series of studies have evaluated associations of GS 8 (GS 3 + 5, GS 4 + 4 and GS 5 + 3) with clinicopathological variables and disease progression 8 . Additionally, oncological outcomes have been evaluated among localized or metastatic PCa patients within GG 4 treated with RP, radiotherapy (RT) and androgen deprivation therapy (ADT) 8 .…”

Section: Introductionmentioning

confidence: 99%

“…A series of studies have evaluated associations of GS 8 (GS 3 + 5, GS 4 + 4 and GS 5 + 3) with clinicopathological variables and disease progression 8 . Additionally, oncological outcomes have been evaluated among localized or metastatic PCa patients within GG 4 treated with RP, radiotherapy (RT) and androgen deprivation therapy (ADT) 8 . However, the impact of the GG 4 subgroups on oncological outcomes has never been investigated in Japanese PCa patients undergoing RARP.…”

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confidence: 99%

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Prognostic differences among Grade Group 4 subgroups in robotic‐assisted radical prostatectomy

et al. 2022

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Objectives To investigate whether the International Society of Urological Pathology Grade Group 4 (GG 4) subgroups have different oncological outcomes in Japanese prostate cancer (PCa) patients undergoing robotic‐assisted radical prostatectomy (RARP). Patients and Methods We conducted a retrospective multicentre cohort study in PCa patients undergoing RARP at 10 institutions in Japan. Pre‐ and post‐operative variables were collected from enrolled patients. We evaluated biochemical recurrence and clinical and pathological variables in the different GG 4 subgroups. Results A total of 3195 patients were enrolled in the study. Among them, 298 patients with GG 4 tumours (pathological Gleason scores [GSs] of 3 + 5 [N = 37], 4 + 4 [N = 257] and 5 + 3 [N = 4]) based on RARP specimens were analysed. The median follow‐up period was 25.2 months. The 3‐year biochemical recurrence (BCR)‐free survival (BCRFS) rate in the overall population was 74.5%. The 3‐year BCRFS rates in the pathological GS 3 + 5, GS 4 + 4 and GS 5 + 3 subgroups were 93.8%, 71.9% and 50.0%, respectively (P = 0.01). In multivariate analysis, pathological GS based on RARP specimens, PSA levels at surgery, pathological T stage, pathological N stage and surgical margins were independent risk factors significantly associated with BCRFS. In particular, patients with pathological GSs 4 + 4 and 5 + 3 were at higher risk of BCR than patients with pathological GS 3 + 5 (hazard ratio 4.54, P = 0.03 and hazard ratio 11.2, P = 0.01, respectively). The study limitations include the lack of central pathological specimen evaluation. Conclusions For patients with localized PCa undergoing RARP, pathological GS 4 + 4 and GS 5 + 3 were significantly associated with worse BCRFS than pathological GS 3 + 5. Pathological GS 3 + 5 may be overrated in GG 4. This observation emphasizes that primary and secondary GS should be considered to accurately stratify the risk of BCR after RARP.

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ASO Author Reflections: Is There Any Difference Among Various Gleason Scores Classified as Grade Group 4 Prostate Cancer?

Mori

Egawa

et al. 2021

Ann Surg Oncol

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A systematic review and meta-analysis of prognostic impact of different Gleason patterns in ISUP grade group 4

Cited by 4 publications

References 28 publications

Prognostic Impact of Different Gleason Patterns on Biopsy Within Grade Group 4 Prostate Cancer

Prognostic Impact of Different Gleason Patterns on Biopsy Within Grade Group 4 Prostate Cancer

Prognostic differences among Grade Group 4 subgroups in robotic‐assisted radical prostatectomy

ASO Author Reflections: Is There Any Difference Among Various Gleason Scores Classified as Grade Group 4 Prostate Cancer?

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