title: Size-adjusted Quantitative Gleason Score as a Predictor of Biochemical Recurrence after Radical Prostatectomy.
abstract: The risk of biochemical recurrence (BCR) following radical prostatectomy for pathologic Gleason 7 prostate cancer varies according to the proportion of Gleason 4 component.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Associations between the above metrics and BCR were evaluated using Cox proportional hazards regression analysis.
  
  
  
  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).
  
  
  
  Quantitative measures of Gleason pattern 4 predict BCR better than the traditional Gleason score.
  
  
  
  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.
authors.affiliation: Department of Pathology, New York University School of Medicine, New York, NY, USA.
authors.forename: Fang-Ming
authors.initials: FM
authors.lastname: Deng
authors.affiliation: Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. Electronic address: ndonin@mednet.ucla.edu.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Donin
authors.affiliation: Department of Pathology, New York University School of Medicine, New York, NY, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Pe Benito
authors.affiliation: Department of Pathology, New York University School of Medicine, New York, NY, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Melamed
authors.affiliation: Department of Urology, New York University School of Medicine, New York, NY, USA.
authors.forename: Julien
authors.initials: J
authors.lastname: Le Nobin
authors.affiliation: Department of Pathology, New York University School of Medicine, New York, NY, USA; Department of Urology, New York University School of Medicine, New York, NY, USA.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhou
authors.affiliation: Center for Health Informatics and Bioinformatics, New York University School of Medicine, New York, NY, USA.
authors.forename: Sisi
authors.initials: S
authors.lastname: Ma
authors.affiliation: Center for Health Informatics and Bioinformatics, New York University School of Medicine, New York, NY, USA; NYU Cancer Institute, New York University School of Medicine, New York, NY, USA.
authors.forename: Jinhua
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Urology, New York University School of Medicine, New York, NY, USA.
authors.forename: Herbert
authors.initials: H
authors.lastname: Lepor
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods; D017063:Outcome Assessment, Health Care; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000032:analysis; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods; D047368:Tumor Burden
chemical_list: D017430:Prostate-Specific Antigen
keywords: Gleason score; Humans; Neoplasm grading; Neoplasm recurrence; Prognosis; Prostatectomy; Prostatic neoplasms; Risk assessment; Tumor volume