1. Prognostic Utility of the Gleason Grading System Revisions and Histopathological Factors Beyond Gleason Grade.
- Author
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Zelic, Renata, Giunchi, Francesca, Fridfeldt, Jonna, Carlsson, Jessica, Davidsson, Sabina, Lianas, Luca, Mascia, Cecilia, Zugna, Daniela, Molinaro, Luca, Vincent, Per Henrik, Zanetti, Gianluigi, Andrén, Ove, Richiardi, Lorenzo, Akre, Olof, Fiorentino, Michelangelo, and Pettersson, Andreas
- Subjects
GLEASON grading system ,DEATH forecasting ,PROSTATE cancer patients ,HISTOPATHOLOGY ,MUCINOUS adenocarcinoma - Abstract
Background: The International Society of Urological Pathology (ISUP) revised the Gleason system in 2005 and 2014. The impact of these changes on prostate cancer (PCa) prognostication remains unclear. Objective: To evaluate if the ISUP 2014 Gleason score (GS) predicts PCa death better than the pre-2005 GS, and if additional histopathological information can further improve PCa death prediction. Patients and Methods: We conducted a case–control study nested among men in the National Prostate Cancer Register of Sweden diagnosed with non-metastatic PCa 1998– 2015. We included 369 men who died from PCa (cases) and 369 men who did not (controls). Two uro-pathologists centrally re-reviewed biopsy ISUP 2014 Gleason grading, poorly formed glands, cribriform pattern, comedonecrosis, perineural invasion, intraductal, ductal and mucinous carcinoma, percentage Gleason 4, inflammation, high-grade prostatic intraepithelial neoplasia (HGPIN) and post-atrophic hyperplasia. Pre-2005 GS was back-transformed using i) information on cribriform pattern and/or poorly formed glands and ii) the diagnostic GS from the registry. Models were developed using Firth logistic regression and compared in terms of discrimination (AUC). Results: The ISUP 2014 GS (AUC = 0.808) performed better than the pre-2005 GS when back-transformed using only cribriform pattern (AUC = 0.785) or both cribriform and poorly formed glands (AUC = 0.792), but not when back-transformed using only poorly formed glands (AUC = 0.800). Similarly, the ISUP 2014 GS performed better than the diagnostic GS (AUC = 0.808 vs 0.781). Comedonecrosis (AUC = 0.811), HGPIN (AUC = 0.810) and number of cores with ? 50% cancer (AUC = 0.810) predicted PCa death independently of the ISUP 2014 GS. Conclusion: The Gleason Grading revisions have improved PCa death prediction, likely due to classifying cribriform patterns, rather than poorly formed glands, as Gleason 4. Comedonecrosis, HGPIN and number of cores with ? 50% cancer further improve PCa death discrimination slightly. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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