Grade Groups Provide Improved Predictions of Pathological and Early Oncologic Outcomes Compared with Gleason Score Risk Groups

No AccessJournal of UrologyAdult Urology1 Feb 2019Grade Groups Provide Improved Predictions of Pathological and Early Oncologic Outcomes Compared with Gleason Score Risk Groups Samer Kirmiz, Ji Qi, Stephen K. Babitz, Susan Linsell, Brian Denton, Karandeep Singh, Gregory Auffenberg, James E. Montie, and Brian R. Lane Samer KirmizSamer Kirmiz College of Human Medicine, Michigan State University, Grand Rapids, Michigan , Ji QiJi Qi Departments of Urology, University of Michigan Medical School, Ann Arbor, Michigan , Stephen K. BabitzStephen K. Babitz Spectrum Health Hospital System, Grand Rapids, Michigan , Susan LinsellSusan Linsell Departments of Urology, University of Michigan Medical School, Ann Arbor, Michigan , Brian DentonBrian Denton Departments of Urology, University of Michigan Medical School, Ann Arbor, Michigan , Karandeep SinghKarandeep Singh Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan , Gregory AuffenbergGregory Auffenberg Departments of Urology, University of Michigan Medical School, Ann Arbor, Michigan , James E. MontieJames E. Montie Departments of Urology, University of Michigan Medical School, Ann Arbor, Michigan , and Brian R. LaneBrian R. Lane †Correspondence and requests for reprints: Urology Division, Spectrum Health Medical Group, 4069 Lake Dr., Suite 313, Grand Rapids, Michigan 49546 (telephone: 616-267-9333; FAX: 616-267-8040; e-mail: E-mail Address: [email protected]). College of Human Medicine, Michigan State University, Grand Rapids, Michigan Spectrum Health Hospital System, Grand Rapids, Michigan View All Author Informationhttps://doi.org/10.1016/j.juro.2018.08.081AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The GG (Grade Group) system was introduced in 2013. Data from academic centers suggest that GG better distinguishes between prostate cancer risk groups than the Gleason score (GS) risk groups. We compared the performance of the 2 systems to predict pathological/recurrence outcomes using data from the MUSIC (Michigan Urological Surgery Improvement Collaborative). Materials and Methods: Patients who underwent biopsy and radical prostatectomy in the MUSIC from March 2012 to June 2017 were classified according to GG and GS. Outcomes included the presence or absence of extraprostatic extension, seminal vesical invasion, positive lymph nodes, positive surgical margins and time to cancer recurrence (defined as postoperative prostate specific antigen 0.2 ng/ml or greater). Logistic and Cox regression models were used to compare the difference in outcomes. Results: A total of 8,052 patients were identified. When controlling for patient characteristics, significantly higher risks of extraprostatic extension, seminal vesical invasion and positive lymph nodes were observed for biopsy GG 3 vs 2 and for GG 5 vs 4 (p <0.001). Biopsy GGs 3, 4 and 5 also showed shorter time to biochemical recurrence than GGs 2, 3 and 4, respectively (p <0.001). GGs 3, 4 and 5 at radical prostatectomy were each associated with a greater probability of recurrence compared to the next lower GG (p <0.001). GG (vs GS) had better predictive power for extraprostatic extension, seminal vesical invasion, positive lymph nodes and biochemical recurrence. Conclusions: GG at biopsy and radical prostatectomy allows for better discrimination of recurrence-free survival between individual risk groups than GS risk groups with GGs 2, 3, 4 and 5 each incrementally associated with increased risk. References 1. : Classification of prostatic carcinomas. Cancer Chemother Rep 1966; 50: 125. Medline, Google Scholar 2. : An update of the Gleason grading system. J Urol 2010; 183: 433. Link, Google Scholar 3. : The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol 2005; 29: 1228. Google Scholar 4. : The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol 2016; 40: 244. 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Link, Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Supported by Blue Cross Blue Shield of Michigan, the Betz Family Endowment for Cancer Research and the Spectrum Health Foundation. No direct or indirect commercial incentive associated with publishing this article. Editor's Note: This article is the third of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 404 and 405. © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue 2February 2019Page: 278-283Supplementary Materials Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.Keywordsriskprostatectomyprostatic neoplasmsmortalityneoplasm gradingMetricsAuthor Information Samer Kirmiz College of Human Medicine, Michigan State University, Grand Rapids, Michigan More articles by this author Ji Qi Departments of Urology, University of Michigan Medical School, Ann Arbor, Michigan More articles by this author Stephen K. Babitz Spectrum Health Hospital System, Grand Rapids, Michigan More articles by this author Susan Linsell Departments of Urology, University of Michigan Medical School, Ann Arbor, Michigan More articles by this author Brian Denton Departments of Urology, University of Michigan Medical School, Ann Arbor, Michigan More articles by this author Karandeep Singh Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan Financial interest and/or other relationship with the NIH (National Institutes of Health)/NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases). More articles by this author Gregory Auffenberg Departments of Urology, University of Michigan Medical School, Ann Arbor, Michigan More articles by this author James E. Montie Departments of Urology, University of Michigan Medical School, Ann Arbor, Michigan More articles by this author Brian R. Lane College of Human Medicine, Michigan State University, Grand Rapids, Michigan Spectrum Health Hospital System, Grand Rapids, Michigan †Correspondence and requests for reprints: Urology Division, Spectrum Health Medical Group, 4069 Lake Dr., Suite 313, Grand Rapids, Michigan 49546 (telephone: 616-267-9333; FAX: 616-267-8040; e-mail: E-mail Address: [email protected]). More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Supported by Blue Cross Blue Shield of Michigan, the Betz Family Endowment for Cancer Research and the Spectrum Health Foundation. No direct or indirect commercial incentive associated with publishing this article. Editor's Note: This article is the third of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 404 and 405. Advertisement PDF downloadLoading ...