Predictive efficacy of the 2014 International Society of Urological Pathology Gleason grading system in initially diagnosed metastatic prostate cancer

• Published in: Asian journal of andrology 2017-09, Vol.19 (5), p.573-578
• Main Authors: Sun, Guang-Xi, Shen, Peng-Fei, Zhang, Xing-Ming, Gong, Jing, Gui, Hao-Jun, Shu, Kun-Peng, Liu, Jiang-Dong, Zhao, Jinge, Yang, Yao-Jing, Chen, Xue-Qin, Chen, Ni, Zeng, Hao
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Aged, 80 and over; Androgens; Antigens; Biopsy; Bone Neoplasms - secondary; Cancer metastasis; Cancer therapies; castration-resistance prostate cancer-free survival; International Society of Urological Pathology grading system; metastasis; overall survival; prostate cancer; China - epidemiology; Development and progression; Diagnosis; Disease-Free Survival; Humans; Kaplan-Meier Estimate; Lymphatic system; Male; Medical prognosis; Metastasis; Middle Aged; Mortality; Neoplasm Grading - methods; Neoplasm Metastasis - pathology; Original; Pathology; Patients; Predictive Value of Tests; Prognosis; Prostate cancer; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Prostatic Neoplasms, Castration-Resistant - mortality; Prostatic Neoplasms, Castration-Resistant - pathology; Risk assessment; Software; Survival Analysis; Treatment Outcome
• ISSN: 1008-682X; 1745-7262
• DOI: 10.4103/1008-682X.186184

We compared the predictive ability of the 2014 and 2005 Gleason grading systems in 568 patients initially diagnosed with metastatic prostate cancer (PCa). Outcomes included the duration of castration-resistant prostate cancer-free survival (CFS) and overall survival (OS). Univariate analyses and log-rank tests were used to identify prognosis indicators and assess univariable differences in CFS and OS in Gleason score (GS) groups. Cox proportional hazards and area under the curves of receiver operator characteristics methods were used to evaluate the predictive efficacy of the 2005 and 2014 ISUP grading systems. Univariate analyses showed that the 2005 and 2014 grading systems were prognosticators for CFS and OS; both systems could distinguish the clinical outcome of patients with GS 6, GS 7, and GS 8-10. Using the 2014 criteria, no statistical differences in patient survival were observed between GS 3 + 4 and GS 4 + 3 or GS 8 and GS 9-10. The predictive ability of the 2014 and 2005 grading systems was comparable for CFS and OS (P = 0.321). However, the 2014 grading system did not exhibit superior predictive efficacy in patients initially diagnosed with PCa and bone metastasis; trials using larger cohorts are required to confirm its predictive value. To the best of our knowledge, ours is the first study to compare the 2005 and 2014 grading systems in initially diagnosed PCa with bone metastasis. At present, we recommend that both systems should be used to predict the prognosis of patients with metastatic PCa.