MP09-05 DOES THE NEW PROSTATE CANCER GRADING SYSTEM IMPROVE PREDICTION OF CLINICAL RECURRENCE?

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II1 Apr 2016MP09-05 DOES THE NEW PROSTATE CANCER GRADING SYSTEM IMPROVE PREDICTION OF CLINICAL RECURRENCE? Paolo Dell'Oglio, Stephen A. Boorjian, Nicola Fossati, Giorgio Gandaglia, Andrea Gallina, Emanuele Zaffuto, Marco Bianchi, Massimo Freschi, Claudio Doglioni, Pierre Karakiewicz, Francesco Montorsi, Jeffrey R. Karnes, and Alberto Briganti Paolo Dell'OglioPaolo Dell'Oglio More articles by this author , Stephen A. BoorjianStephen A. Boorjian More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Marco BianchiMarco Bianchi More articles by this author , Massimo FreschiMassimo Freschi More articles by this author , Claudio DoglioniClaudio Doglioni More articles by this author , Pierre KarakiewiczPierre Karakiewicz More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Jeffrey R. KarnesJeffrey R. Karnes More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2292AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recently, a new prostate cancer (PCa) grading system (namely, ≤6 vs. 3+4 vs. 4+3 vs. 8 vs. ≥9) has been proposed and assessed on biochemical recurrence (BCR) showing improved predictive abilities compared to the standard Gleason (GS) grading system. We assessed the predictive ability of the new PCa grading system on harder clinical endpoint, such as clinical recurrence (CR). METHODS Between 2005 and 2014, 9,728 clinically localized PCa patients were treated with radical prostatectomy (RP) at two tertiary referral centres. Patients who received neo-adjuvant therapy were excluded. Kaplan-Meier curves were used to assess CR after treatment according to 4 GS Groups at biopsy and RP: Group 1: ≤6 vs. 7 vs. ≥8; Group 2: ≤6 vs. 3+4 vs. 4+3 vs. ≥8; Group 3: ≤6 vs. 7 vs. 8 vs. ≥9; Group 4: ≤6 vs. 3+4 vs. 4+3 vs. 8 vs. ≥9. Multivariable Cox regression analyses were performed to assess predictors of CR using each of the 4 Groups of GS. The pretreatment models were adjusted for age at surgery, preoperative PSA and clinical stage (T1 vs. T2. vs. T3-T4) and for the 4 Groups of GS. The post-treatment models were adjusted for age at surgery, preoperative PSA, pathologic stage (pT2 vs. pT3a vs. pT3b vs. pT4), surgical margin, lymph node invasion, number of lymph nodes removed, adjuvant radiotherapy, adjuvant hormonal therapy, and for the 4 Groups of GS. These were also tested exclusively in patients who had BCR (n=1,624) using the same post-treatment models adjusting also for time to BCR. Leave-one-out cross validation (LOOCV) was used to assess the discrimination of the 4 possible Groups of GS in all models. RESULTS Overall, 443 (4.6%) patients had CR. In the pre-treatment model, the hazard ratio (HR) relative to GS≤6 vs. 3+4 vs. 4+3 vs. 8 vs. ≥9 was 3.6 vs. 5.9 vs. 11.4 vs. 18.1, respectively. In the post-treatment model, the HR relative to GS≤6 vs. 3+4 vs. 4+3 vs. 8 vs. ≥9 was 4.9 vs. 9.9 vs. 15.3 vs. 25.1, respectively. After LOOCV, in the pre-treatment model the C-index was 0.790 in Group 1 vs. 0.795 in Group 2 vs. 0.791 in Group 3 vs. 0.796 in Group 4. After LOOCV, in the post-treatment model the C-index was 0.827 in Group 1 vs. 0.835 in Group 2 vs. 0.828 in Group 3 vs. 0.835 in Group 4. In sub-analyses in patients who had BCR, the C-index was 0.691 in Group 1 vs. 0.693 in Group 2 vs. 0.692 in Group 3 vs. 0.693 in Group 4. CONCLUSIONS The accuracy difference of the new PCa grading compared to the others GS Groups, using hard clinical endpoint such as clinical recurrence, is clinically negligible. These results should be taken into account in view of the introduction of this proposed system into clinical practice. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e95 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Paolo Dell'Oglio More articles by this author Stephen A. Boorjian More articles by this author Nicola Fossati More articles by this author Giorgio Gandaglia More articles by this author Andrea Gallina More articles by this author Emanuele Zaffuto More articles by this author Marco Bianchi More articles by this author Massimo Freschi More articles by this author Claudio Doglioni More articles by this author Pierre Karakiewicz More articles by this author Francesco Montorsi More articles by this author Jeffrey R. Karnes More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...