Population-Based Validation of the 2014 ISUP Gleason Grade Groups in Patients Treated With Radical Prostatectomy, Brachytherapy, External Beam Radiation, or no Local Treatment.
BACKGROUND
To test discriminant ability of the 2014 ISUP Gleason grade groups (GGG) for prediction of prostate cancer specific mortality (PCSM) after radical prostatectomy (RP), brachytherapy (BT), external beam radiation (EBRT) or no local treatment (NLT) relative to traditional Gleason grading (TGG).


METHODS
In the Surveillance, Epidemiology, and End Results (SEER)-database (2004-2009), 2,42,531 non-metastatic prostate cancer (PCa) patients were identified, who underwent local treatment (RP, BT, EBRT only) or NLT. Follow-up endpoint was PCSM. Biopsy and/or pathological Gleason score (GS) were categorized as TGG ≤6, 7, 8-10 or GGG: I (≤6), II (3 + 4), III (4 + 3), IV (8), and V (9-10). Kaplan-Meier plots, multivariable Cox regression analyses and receiver operating characteristics (ROC) area under the curve analyses (AUC) were used.


RESULTS
Median follow-up was 76 months (IQR: 59-94). For the four examined treatment modalities, all five GGG strata and all three TGG strata independently predicted PCSM. GGG yielded 1.5-fold or greater HR differences between GGG II and GGG III, and twofold or greater HR differences between GGG IV and GGG V. Relative to TGG, GGG added 0.4-1.1% to AUC.


CONCLUSIONS
This large population-based cohort study confirms the added discriminant properties of the novel GGG strata and confirms a modest gain in predictive accuracy. Prostate 77: 686-693, 2017. © 2017 Wiley Periodicals, Inc.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.|Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Raisa S
RS
Pompe
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.|Department of Urology, University of Montreal Health Center, Montreal, Canada.
Helen
H
Davis-Bondarenko
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.|Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Emanuele
E
Zaffuto
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
Zhe
Z
Tian
Department of Urology, Medical University of Vienna, Vienna, Austria.
Shahrokh F
SF
Shariat
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.|Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.|Department of Urology, University Hcoospital Hamburg-Eppendorf, Hamburg, Germany.
Sami-Ramzi
SR
Leyh-Bannurah
Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany.
Jonas
J
Schiffmann
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.|Department of Urology, University of Montreal Health Center, Montreal, Canada.
Fred
F
Saad
Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Hartwig
H
Huland
Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Markus
M
Graefen
Martini-Clinic, Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.|Department of Urology, University Hcoospital Hamburg-Eppendorf, Hamburg, Germany.
Derya
D
Tilki
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.|Department of Urology, University of Montreal Health Center, Montreal, Canada.
Pierre I
PI
Karakiewicz
D000368:Aged; D001918:Brachytherapy / Q000379:methods / Q000592:standards*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011468:Prostatectomy / Q000379:methods / Q000592:standards*; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery*; D061766:Proton Therapy / Q000379:methods / Q000592:standards*; D018426:SEER Program / Q000592:standards; D016896:Treatment Outcome
Epstein; Gleason grade; prostate cancer specific mortality; validation