A Tertiary Gleason Pattern in the Prostatectomy Specimen and its Association with Adverse Outcome after Radical Prostatectomy
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A Tertiary Gleason Pattern in the Prostatectomy Specimen and its Association with Adverse Outcome after Radical Prostatectomy. / Adam, Meike; Hannah, Amir; Budäus, Lars; Steuber, Thomas; Salomon, Georg; Michl, Uwe; Haese, Alexander; Fisch, Margit; Wittmer, Corinna; Steurer, Stefan; Minner, Sarah; Heinzer, Hans; Huland, Hartwig; Graefen, Markus; Sauter, Guido; Schlomm, Thorsten; Isbarn, Hendrik.
in: J UROLOGY, Jahrgang 192, Nr. 1, 08.02.2014, S. 97-101.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - A Tertiary Gleason Pattern in the Prostatectomy Specimen and its Association with Adverse Outcome after Radical Prostatectomy
AU - Adam, Meike
AU - Hannah, Amir
AU - Budäus, Lars
AU - Steuber, Thomas
AU - Salomon, Georg
AU - Michl, Uwe
AU - Haese, Alexander
AU - Fisch, Margit
AU - Wittmer, Corinna
AU - Steurer, Stefan
AU - Minner, Sarah
AU - Heinzer, Hans
AU - Huland, Hartwig
AU - Graefen, Markus
AU - Sauter, Guido
AU - Schlomm, Thorsten
AU - Isbarn, Hendrik
N1 - Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
PY - 2014/2/8
Y1 - 2014/2/8
N2 - PURPOSE: The prognostic significance of a tertiary Gleason pattern in the radical prostatectomy specimen is controversial. We tested the impact of a tertiary Gleason pattern on adverse histopathological features and biochemical recurrence rates after radical prostatectomy.MATERIALS AND METHODS: We assessed data on 11,226 consecutive patients treated with radical prostatectomy at our institution between June 2007 and February 2013. We compared 2,396 patients with (22.4%) and 8,260 without (77.5%) a tertiary Gleason pattern for adverse histopathological features (extraprostatic extension, seminal vesicle invasion, positive surgical margins and lymph node invasion) using the chi-square test. The effect of a tertiary Gleason pattern on biochemical recurrence was tested in univariable and multivariable models. Subanalyses were then done for different radical prostatectomy Gleason groups (6 or less, 3 + 4 and 4 + 3).RESULTS: A tertiary Gleason pattern was statistically significantly associated with all evaluated histopathological parameters (each p <0.001). It was an independent predictor of biochemical recurrence (HR 1.43, p <0.001). On subanalysis only a tertiary Gleason pattern independently predicted biochemical recurrence in the patient cohort with a radical prostatectomy Gleason score of 3 + 4 and 4 + 3. However, it failed to attain independent predictor status in patients with a radical prostatectomy Gleason score of 6 or less.CONCLUSIONS: A tertiary Gleason pattern is a significant and independent predictor of biochemical recurrence after radical prostatectomy with the strongest prognostic effect in cases with Gleason scores 3 + 4 and 4 + 3. Therefore, a tertiary Gleason pattern should be recorded in the pathological report.
AB - PURPOSE: The prognostic significance of a tertiary Gleason pattern in the radical prostatectomy specimen is controversial. We tested the impact of a tertiary Gleason pattern on adverse histopathological features and biochemical recurrence rates after radical prostatectomy.MATERIALS AND METHODS: We assessed data on 11,226 consecutive patients treated with radical prostatectomy at our institution between June 2007 and February 2013. We compared 2,396 patients with (22.4%) and 8,260 without (77.5%) a tertiary Gleason pattern for adverse histopathological features (extraprostatic extension, seminal vesicle invasion, positive surgical margins and lymph node invasion) using the chi-square test. The effect of a tertiary Gleason pattern on biochemical recurrence was tested in univariable and multivariable models. Subanalyses were then done for different radical prostatectomy Gleason groups (6 or less, 3 + 4 and 4 + 3).RESULTS: A tertiary Gleason pattern was statistically significantly associated with all evaluated histopathological parameters (each p <0.001). It was an independent predictor of biochemical recurrence (HR 1.43, p <0.001). On subanalysis only a tertiary Gleason pattern independently predicted biochemical recurrence in the patient cohort with a radical prostatectomy Gleason score of 3 + 4 and 4 + 3. However, it failed to attain independent predictor status in patients with a radical prostatectomy Gleason score of 6 or less.CONCLUSIONS: A tertiary Gleason pattern is a significant and independent predictor of biochemical recurrence after radical prostatectomy with the strongest prognostic effect in cases with Gleason scores 3 + 4 and 4 + 3. Therefore, a tertiary Gleason pattern should be recorded in the pathological report.
U2 - 10.1016/j.juro.2014.01.029
DO - 10.1016/j.juro.2014.01.029
M3 - SCORING: Journal article
C2 - 24518778
VL - 192
SP - 97
EP - 101
JO - J UROLOGY
JF - J UROLOGY
SN - 0022-5347
IS - 1
ER -