title: Prognostic value of the new Grade Groups in Prostate Cancer: a multi-institutional European validation study.
abstract: We aimed to assess the prognostic relevance of the new Grade Groups in Prostate Cancer (PCa) within a large cohort of European men treated with radical prostatectomy (RP).
  
  
  
  Data from 27 122 patients treated with RP at seven European centers were analyzed. We investigated the prognostic performance of the new Grade Groups (based on Gleason score 3+3, 3+4, 4+3, 8 and 9-10) on biopsy and RP specimen, adjusted for established clinical and pathological characteristics. Multivariable Cox proportional hazards regression models assessed the association of new Grade Groups with biochemical recurrence (BCR). Prognostic accuracies of the models were assessed using Harrell's C-index.
  
  
  
  Median follow-up was 29 months (interquartile range, 13-54). The 4-year estimated BCR-free survival (bRFS) for biopsy Grade Groups 1-5 were 91.3, 81.6, 69.8, 60.3 and 44.4%, respectively. The 4-year estimated bRFS for RP Grade Groups 1-5 were 96.1%, 86.7%, 67.0%, 63.1% and 41.0%, respectively. Compared with Grade Group 1, all other Grade Groups based both on biopsy and RP specimen were independently associated with a lower bRFS (all P<0.01). Adjusted pairwise comparisons revealed statistically differences between all Grade Groups, except for group 3 and 4 on RP specimen (P=0.10). The discriminations of the multivariable base prognostic models based on the current three-tier and the new five-tier systems were not clinically different (0.3 and 0.9% increase in discrimination for clinical and pathological model).
  
  
  
  We validated the independent prognostic value of the new Grade Groups on biopsy and RP specimen from European PCa men. However, it does not improve the accuracies of prognostic models by a clinically significant margin. Nevertheless, this new classification may help physicians and patients estimate disease aggressiveness with a user-friendly, clinically relevant and reproducible method.
authors.affiliation: Comprehensive Cancer Center, Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria.|Department of Urology, Rennes University Hospital, Rennes, France.
authors.forename: R
authors.initials: R
authors.lastname: Mathieu
authors.affiliation: Comprehensive Cancer Center, Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria.|Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Moschini
authors.affiliation: Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Beyer
authors.affiliation: Comprehensive Cancer Center, Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria.
authors.forename: K M
authors.initials: KM
authors.lastname: Gust
authors.affiliation: Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Seisen
authors.affiliation: Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Karakiewicz
authors.affiliation: Comprehensive Cancer Center, Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Seitz
authors.affiliation: Service d'urologie et de transplantation, CHU Henri- Mondor, Créteil Cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Salomon
authors.affiliation: Service d'urologie et de transplantation, CHU Henri- Mondor, Créteil Cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: de la Taille
authors.affiliation: Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Rouprêt
authors.affiliation: Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Graefen
authors.affiliation: Comprehensive Cancer Center, Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria.|Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.|Department of Urology, Weill Cornell Medical College, New York, NY, USA.|Karl Landsteiner Institute, Vienna, Austria.
authors.forename: S F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D000368:Aged; D001706:Biopsy; D005060:Europe; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011467:Prostate / Q000473:pathology; D011471:Prostatic Neoplasms / Q000145:classification / Q000453:epidemiology* / Q000473:pathology*