Size-adjusted Quantitative Gleason Score as a Predictor of Biochemical Recurrence after Radical Prostatectomy

Fang Ming Deng, Nicholas M. Donin, Ruth Pe Benito, Jonathan Melamed, Julien Le Nobin, Ming Zhou, Sisi Ma, Jinhua Wang, Herbert Lepor

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background The risk of biochemical recurrence (BCR) following radical prostatectomy for pathologic Gleason 7 prostate cancer varies according to the proportion of Gleason 4 component. Objective We sought to explore the value of several novel quantitative metrics of Gleason 4 disease for the prediction of BCR in men with Gleason 7 disease. Design, setting, and participants We analyzed a cohort of 2630 radical prostatectomy cases from 1990–2007. All pathologic Gleason 7 cases were identified and assessed for quantity of Gleason pattern 4. Three methods were used to quantify the extent of Gleason 4: a quantitative Gleason score (qGS) based on the proportion of tumor composed of Gleason pattern 4, a size-weighted score (swGS) incorporating the overall quantity of Gleason 4, and a size index (siGS) incorporating the quantity of Gleason 4 based on the index lesion. Outcome measurements and statistical analysis Associations between the above metrics and BCR were evaluated using Cox proportional hazards regression analysis. Results and limitations qGS, swGS, and siGS were significantly associated with BCR on multivariate analysis when adjusted for traditional Gleason score, age, prostate specific antigen, surgical margin, and stage. Using Harrell's c-index to compare the scoring systems, qGS (0.83), swGS (0.84), and siGS (0.84) all performed better than the traditional Gleason score (0.82). Conclusions Quantitative measures of Gleason pattern 4 predict BCR better than the traditional Gleason score. Patient summary In men with Gleason 7 prostate cancer, quantitative analysis of the proportion of Gleason pattern 4 (quantitative Gleason score), as well as size-weighted measurement of Gleason 4 (size-weighted Gleason score), and a size-weighted measurement of Gleason 4 based on the largest tumor nodule significantly improve the predicted risk of biochemical recurrence compared with the traditional Gleason score.

Original languageEnglish (US)
Pages (from-to)248-253
Number of pages6
JournalEuropean Urology
Volume70
Issue number2
DOIs
StatePublished - Aug 1 2016

Fingerprint

Neoplasm Grading
Prostatectomy
Recurrence
Prostatic Neoplasms
Prostate-Specific Antigen
Neoplasms
Multivariate Analysis
Regression Analysis

Keywords

  • Gleason score
  • Humans
  • Neoplasm grading
  • Neoplasm recurrence
  • Prognosis
  • Prostatectomy
  • Prostatic neoplasms
  • Risk assessment
  • Tumor volume

ASJC Scopus subject areas

  • Urology

Cite this

Deng, F. M., Donin, N. M., Pe Benito, R., Melamed, J., Le Nobin, J., Zhou, M., ... Lepor, H. (2016). Size-adjusted Quantitative Gleason Score as a Predictor of Biochemical Recurrence after Radical Prostatectomy. European Urology, 70(2), 248-253. https://doi.org/10.1016/j.eururo.2015.10.026

Size-adjusted Quantitative Gleason Score as a Predictor of Biochemical Recurrence after Radical Prostatectomy. / Deng, Fang Ming; Donin, Nicholas M.; Pe Benito, Ruth; Melamed, Jonathan; Le Nobin, Julien; Zhou, Ming; Ma, Sisi; Wang, Jinhua; Lepor, Herbert.

In: European Urology, Vol. 70, No. 2, 01.08.2016, p. 248-253.

Research output: Contribution to journalArticle

Deng, FM, Donin, NM, Pe Benito, R, Melamed, J, Le Nobin, J, Zhou, M, Ma, S, Wang, J & Lepor, H 2016, 'Size-adjusted Quantitative Gleason Score as a Predictor of Biochemical Recurrence after Radical Prostatectomy', European Urology, vol. 70, no. 2, pp. 248-253. https://doi.org/10.1016/j.eururo.2015.10.026
Deng, Fang Ming ; Donin, Nicholas M. ; Pe Benito, Ruth ; Melamed, Jonathan ; Le Nobin, Julien ; Zhou, Ming ; Ma, Sisi ; Wang, Jinhua ; Lepor, Herbert. / Size-adjusted Quantitative Gleason Score as a Predictor of Biochemical Recurrence after Radical Prostatectomy. In: European Urology. 2016 ; Vol. 70, No. 2. pp. 248-253.
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title = "Size-adjusted Quantitative Gleason Score as a Predictor of Biochemical Recurrence after Radical Prostatectomy",
abstract = "Background The risk of biochemical recurrence (BCR) following radical prostatectomy for pathologic Gleason 7 prostate cancer varies according to the proportion of Gleason 4 component. Objective We sought to explore the value of several novel quantitative metrics of Gleason 4 disease for the prediction of BCR in men with Gleason 7 disease. Design, setting, and participants We analyzed a cohort of 2630 radical prostatectomy cases from 1990–2007. All pathologic Gleason 7 cases were identified and assessed for quantity of Gleason pattern 4. Three methods were used to quantify the extent of Gleason 4: a quantitative Gleason score (qGS) based on the proportion of tumor composed of Gleason pattern 4, a size-weighted score (swGS) incorporating the overall quantity of Gleason 4, and a size index (siGS) incorporating the quantity of Gleason 4 based on the index lesion. Outcome measurements and statistical analysis Associations between the above metrics and BCR were evaluated using Cox proportional hazards regression analysis. Results and limitations qGS, swGS, and siGS were significantly associated with BCR on multivariate analysis when adjusted for traditional Gleason score, age, prostate specific antigen, surgical margin, and stage. Using Harrell's c-index to compare the scoring systems, qGS (0.83), swGS (0.84), and siGS (0.84) all performed better than the traditional Gleason score (0.82). Conclusions Quantitative measures of Gleason pattern 4 predict BCR better than the traditional Gleason score. Patient summary In men with Gleason 7 prostate cancer, quantitative analysis of the proportion of Gleason pattern 4 (quantitative Gleason score), as well as size-weighted measurement of Gleason 4 (size-weighted Gleason score), and a size-weighted measurement of Gleason 4 based on the largest tumor nodule significantly improve the predicted risk of biochemical recurrence compared with the traditional Gleason score.",
keywords = "Gleason score, Humans, Neoplasm grading, Neoplasm recurrence, Prognosis, Prostatectomy, Prostatic neoplasms, Risk assessment, Tumor volume",
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T1 - Size-adjusted Quantitative Gleason Score as a Predictor of Biochemical Recurrence after Radical Prostatectomy

AU - Deng, Fang Ming

AU - Donin, Nicholas M.

AU - Pe Benito, Ruth

AU - Melamed, Jonathan

AU - Le Nobin, Julien

AU - Zhou, Ming

AU - Ma, Sisi

AU - Wang, Jinhua

AU - Lepor, Herbert

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background The risk of biochemical recurrence (BCR) following radical prostatectomy for pathologic Gleason 7 prostate cancer varies according to the proportion of Gleason 4 component. Objective We sought to explore the value of several novel quantitative metrics of Gleason 4 disease for the prediction of BCR in men with Gleason 7 disease. Design, setting, and participants We analyzed a cohort of 2630 radical prostatectomy cases from 1990–2007. All pathologic Gleason 7 cases were identified and assessed for quantity of Gleason pattern 4. Three methods were used to quantify the extent of Gleason 4: a quantitative Gleason score (qGS) based on the proportion of tumor composed of Gleason pattern 4, a size-weighted score (swGS) incorporating the overall quantity of Gleason 4, and a size index (siGS) incorporating the quantity of Gleason 4 based on the index lesion. Outcome measurements and statistical analysis Associations between the above metrics and BCR were evaluated using Cox proportional hazards regression analysis. Results and limitations qGS, swGS, and siGS were significantly associated with BCR on multivariate analysis when adjusted for traditional Gleason score, age, prostate specific antigen, surgical margin, and stage. Using Harrell's c-index to compare the scoring systems, qGS (0.83), swGS (0.84), and siGS (0.84) all performed better than the traditional Gleason score (0.82). Conclusions Quantitative measures of Gleason pattern 4 predict BCR better than the traditional Gleason score. Patient summary In men with Gleason 7 prostate cancer, quantitative analysis of the proportion of Gleason pattern 4 (quantitative Gleason score), as well as size-weighted measurement of Gleason 4 (size-weighted Gleason score), and a size-weighted measurement of Gleason 4 based on the largest tumor nodule significantly improve the predicted risk of biochemical recurrence compared with the traditional Gleason score.

AB - Background The risk of biochemical recurrence (BCR) following radical prostatectomy for pathologic Gleason 7 prostate cancer varies according to the proportion of Gleason 4 component. Objective We sought to explore the value of several novel quantitative metrics of Gleason 4 disease for the prediction of BCR in men with Gleason 7 disease. Design, setting, and participants We analyzed a cohort of 2630 radical prostatectomy cases from 1990–2007. All pathologic Gleason 7 cases were identified and assessed for quantity of Gleason pattern 4. Three methods were used to quantify the extent of Gleason 4: a quantitative Gleason score (qGS) based on the proportion of tumor composed of Gleason pattern 4, a size-weighted score (swGS) incorporating the overall quantity of Gleason 4, and a size index (siGS) incorporating the quantity of Gleason 4 based on the index lesion. Outcome measurements and statistical analysis Associations between the above metrics and BCR were evaluated using Cox proportional hazards regression analysis. Results and limitations qGS, swGS, and siGS were significantly associated with BCR on multivariate analysis when adjusted for traditional Gleason score, age, prostate specific antigen, surgical margin, and stage. Using Harrell's c-index to compare the scoring systems, qGS (0.83), swGS (0.84), and siGS (0.84) all performed better than the traditional Gleason score (0.82). Conclusions Quantitative measures of Gleason pattern 4 predict BCR better than the traditional Gleason score. Patient summary In men with Gleason 7 prostate cancer, quantitative analysis of the proportion of Gleason pattern 4 (quantitative Gleason score), as well as size-weighted measurement of Gleason 4 (size-weighted Gleason score), and a size-weighted measurement of Gleason 4 based on the largest tumor nodule significantly improve the predicted risk of biochemical recurrence compared with the traditional Gleason score.

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KW - Humans

KW - Neoplasm grading

KW - Neoplasm recurrence

KW - Prognosis

KW - Prostatectomy

KW - Prostatic neoplasms

KW - Risk assessment

KW - Tumor volume

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