Integrating Tertiary Gleason 5 Patterns into Quantitative Gleason Grading in Prostate Biopsies and Prostatectomy Specimens
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Integrating Tertiary Gleason 5 Patterns into Quantitative Gleason Grading in Prostate Biopsies and Prostatectomy Specimens. / Sauter, Guido; Clauditz, Till; Steurer, Stefan; Wittmer, Corinna; Büscheck, Franziska; Krech, Till; Lutz, Florian; Lennartz, Maximilian; Harms, Luisa; Lawrenz, Lisa; Möller-Koop, Christina; Simon, Ronald; Jacobsen, Frank; Wilczak, Waldemar; Minner, Sarah; Tsourlakis, Maria Christina; Chirico, Viktoria; Weidemann, Sören; Haese, Alexander; Steuber, Thomas; Salomon, Georg; Matiu, Michael; Vettorazzi, Eik; Michl, Uwe; Budäus, Lars; Tilki, Derya; Thederan, Imke; Pehrke, Dirk; Beyer, Burkhard; Fraune, Christoph; Göbel, Cosima; Heinrich, Marie; Juhnke, Manuela; Möller, Katharina; Bawahab, Ahmed Abdulwahab Abdullah; Uhlig, Ria; Huland, Hartwig; Heinzer, Hans; Graefen, Markus; Schlomm, Thorsten.
In: EUR UROL, Vol. 73, No. 5, 05.2018, p. 674-683.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Integrating Tertiary Gleason 5 Patterns into Quantitative Gleason Grading in Prostate Biopsies and Prostatectomy Specimens
AU - Sauter, Guido
AU - Clauditz, Till
AU - Steurer, Stefan
AU - Wittmer, Corinna
AU - Büscheck, Franziska
AU - Krech, Till
AU - Lutz, Florian
AU - Lennartz, Maximilian
AU - Harms, Luisa
AU - Lawrenz, Lisa
AU - Möller-Koop, Christina
AU - Simon, Ronald
AU - Jacobsen, Frank
AU - Wilczak, Waldemar
AU - Minner, Sarah
AU - Tsourlakis, Maria Christina
AU - Chirico, Viktoria
AU - Weidemann, Sören
AU - Haese, Alexander
AU - Steuber, Thomas
AU - Salomon, Georg
AU - Matiu, Michael
AU - Vettorazzi, Eik
AU - Michl, Uwe
AU - Budäus, Lars
AU - Tilki, Derya
AU - Thederan, Imke
AU - Pehrke, Dirk
AU - Beyer, Burkhard
AU - Fraune, Christoph
AU - Göbel, Cosima
AU - Heinrich, Marie
AU - Juhnke, Manuela
AU - Möller, Katharina
AU - Bawahab, Ahmed Abdulwahab Abdullah
AU - Uhlig, Ria
AU - Huland, Hartwig
AU - Heinzer, Hans
AU - Graefen, Markus
AU - Schlomm, Thorsten
N1 - Copyright © 2017. Published by Elsevier B.V.
PY - 2018/5
Y1 - 2018/5
N2 - BACKGROUND: Presence of small (tertiary) Gleason 5 pattern is linked to a higher risk of biochemical recurrence in prostate cancer. It is unclear, however, how to integrate small Gleason 5 elements into clinically relevant Gleason grade groups.OBJECTIVE: To analyze the prognostic impact of Gleason 5 patterns in prostate cancer and to develop a method for integrating tertiary Gleason 5 patterns into a quantitative Gleason grading system.DESIGN, SETTING, AND PARTICIPANTS: Prostatectomy specimens from 13 261 consecutive patients and of 3295 matched preoperative biopsies were available. Percentages of Gleason 3, 4, and 5 had been recorded for each cancer. Outcome measurements and statistical analysis: RESULTS AND LIMITATIONS: Our data demonstrate that minimal Gleason 5 areas have strong prognostic impact in Gleason 7 carcinomas, while further expansion of the Gleason 5 pattern population has less impact. We thus defined an integrated quantitative Gleason score (IQ-Gleason) by adding a lump score of 10 to the percentage of unfavorable Gleason pattern (Gleason 4/5) if any Gleason 5 was present and by adding another 7.5 points in case of a Gleason 5 fraction >20%. There was a continuous increase of the risk of prostate-specific antigen recurrence with increasing IQ-Gleason. This was also true for subgroups with identical Cancer of the Prostate Risk Assessment Postsurgical scores (p<0.0001) or Gleason grade groups (p<0.0001).CONCLUSIONS: The IQ-Gleason represents a simple and efficient approach for combining both quantitative Gleason grading and tertiary Gleason grades in one highly prognostic numerical variable.PATIENT SUMMARY: Prostatectomy specimens (13 261) were analyzed to estimate the relevance of small Gleason 5 elements in prostate cancers. Even the smallest Gleason 5 areas markedly increased the risk of prostate-specific antigen recurrence after surgery. Larger fractions of Gleason 5 patterns had less further impact on prognosis. Based on this, a numerical Gleason score (integrated quantitative Gleason score) was defined by the percentages of Gleason 4 and 5 patterns, enabling a refined estimate of patient prognosis.
AB - BACKGROUND: Presence of small (tertiary) Gleason 5 pattern is linked to a higher risk of biochemical recurrence in prostate cancer. It is unclear, however, how to integrate small Gleason 5 elements into clinically relevant Gleason grade groups.OBJECTIVE: To analyze the prognostic impact of Gleason 5 patterns in prostate cancer and to develop a method for integrating tertiary Gleason 5 patterns into a quantitative Gleason grading system.DESIGN, SETTING, AND PARTICIPANTS: Prostatectomy specimens from 13 261 consecutive patients and of 3295 matched preoperative biopsies were available. Percentages of Gleason 3, 4, and 5 had been recorded for each cancer. Outcome measurements and statistical analysis: RESULTS AND LIMITATIONS: Our data demonstrate that minimal Gleason 5 areas have strong prognostic impact in Gleason 7 carcinomas, while further expansion of the Gleason 5 pattern population has less impact. We thus defined an integrated quantitative Gleason score (IQ-Gleason) by adding a lump score of 10 to the percentage of unfavorable Gleason pattern (Gleason 4/5) if any Gleason 5 was present and by adding another 7.5 points in case of a Gleason 5 fraction >20%. There was a continuous increase of the risk of prostate-specific antigen recurrence with increasing IQ-Gleason. This was also true for subgroups with identical Cancer of the Prostate Risk Assessment Postsurgical scores (p<0.0001) or Gleason grade groups (p<0.0001).CONCLUSIONS: The IQ-Gleason represents a simple and efficient approach for combining both quantitative Gleason grading and tertiary Gleason grades in one highly prognostic numerical variable.PATIENT SUMMARY: Prostatectomy specimens (13 261) were analyzed to estimate the relevance of small Gleason 5 elements in prostate cancers. Even the smallest Gleason 5 areas markedly increased the risk of prostate-specific antigen recurrence after surgery. Larger fractions of Gleason 5 patterns had less further impact on prognosis. Based on this, a numerical Gleason score (integrated quantitative Gleason score) was defined by the percentages of Gleason 4 and 5 patterns, enabling a refined estimate of patient prognosis.
U2 - 10.1016/j.eururo.2017.01.015
DO - 10.1016/j.eururo.2017.01.015
M3 - SCORING: Journal article
C2 - 28117112
VL - 73
SP - 674
EP - 683
JO - EUR UROL
JF - EUR UROL
SN - 0302-2838
IS - 5
ER -