Abstract
Purpose: Gleason score (GS) system is one of the most widely used histological grading methods for prostate cancer (PCa) all over the world. GS can be obtained by adding the primary Gleason pattern (GP) and secondary GP. Different proportions of GP 4 and GP 5 in prostate specimens can both lead to GS 9. In this study, we explored whether GP 5 + 4 or GP 4 + 5 was associated with different prognoses among patients with GS 9 PCa.Materials and methods: A retrospective population-based study was conducted on 10,124 subjects diagnosed with GS 9 PCa between 2004 and 2009 from the Surveillance, Epidemiology, and End Results program. A 1:1 propensity-score matching (PSM) was performed to balance the baseline characteristics between the GP 4 + 5 and 5 + 4 groups and to compare the prognoses between the two groups. Cox regression analysis and Fine-Gray competing risk regression models were adopted to screen the covariates significantly associated with all-cause mortality (ACM) and cancer-specific mortality (CAM).Results: GP 5 + 4 was associated with higher risks of ACM and CSM before or after PSM than GP 4 + 5. In the original cohort, there were eight independent predictors for ACM, which were age at diagnosis, race, AJCC NM stage, PSA levels, treatments, GP, and marital status, confirmed by the Cox analysis; and nine independent predictors for CSM, which were age at diagnosis, race, AJCC TNM stage, PSA levels, treatments, GP, and marital status, confirmed by the competing-risk model.Conclusion: GP 5 + 4 was associated with a poorer overall survival and cancer-specific survival compared with GP 4 + 5.
Highlights
Prostate cancer (PCa) was one of the leading genitourinary neoplasms in males all over the world, the incidence rate of PCa differs slightly with the changes in the area and race [1, 2]
Three hundred thirty-one thousand fifty-seven (331,057) patients diagnosed with PCa between 2004 and 2009 were collected from the SEER database
7,759 (74.7%) patients were diagnosed with Gleason patterns (GP) 4 + 5 PCa and 2,565 (25.3%) with GP 5 + 4 PCa
Summary
Prostate cancer (PCa) was one of the leading genitourinary neoplasms in males all over the world, the incidence rate of PCa differs slightly with the changes in the area and race [1, 2]. Prognostic Models for GS 9 PCa of recurrence, metastasis, and mortality [6]. Different Gleason patterns (GP), GP 4 + 5 and 5 + 4, can both lead to GS 9. It has been reported that an increased proportion of Gleason pattern 5 has a trend to be associated with adverse outcomes [7]. Several previous studies have proved differences in the prognoses between patients with GP 4 + 5 and 5 + 4 PCa [8,9,10]. We perform a study with a larger survey sample in the individual level to investigate the differences in the overall survival (OS) and cancer-specific survival (CSS) between the two GPs
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