- Email: [email protected]
716 Biopsy Gleason score ≤ 6. How to predict final pathological specimen Gleason score?
716
Biopsy Gleason score ≤ 6. How to predict final pathological specimen Gleason score? Eur Urol Suppl 2013;12;e716
Seisen T.1, Roudot Thoraval F.2, Bosset P.O.1, Campeggi A.1, Allory Y.3, Vordos D.1, Hoznek A.1, Abbou C-C.1, De La Taille A.1, Salomon L.1 1
Henri Mondor, Dept. of Urology, Creteil, France, 2Henri Mondor, Dept. of Public Health, Creteil, France, 3Henri
Mondor, Dept. of Anatomopathology, Creteil, France INTRODUCTION & OBJECTIVES: Gleason score (GS) is commonly used with clinical stage and PSA level to assess evolution risk of prostate cancer (PCa) and select adequate management. However, biopsy and final pathological specimen GS are inconstantly correlated to each other. Therefore, we aimed to develop and validate a new predictive score to screen patients with biopsy GS ≤ 6 at risk of GS upgrading. MATERIAL & METHODS: Clinical and pathological data of 1179 patients managed with RP for a biopsy GS ≤ 6 PCa between 1998 and 2012 were collected. Inclusion criteria were biopsy GS ≤ 6, clinical stage ≤ T2b and pre-operative PSA ≤ 20 ng/ml. The population study was randomly split into a development (n=822) and a validation (n =357) group. In the development cohort, univariate analysis first identified factors related to GS upgrading. Then, predictive factors of GS upgrading were tested in a forward stepwise logistic regression model. A prognostic score was established using the independent variables and weighted according to the estimated b regression coefficient of the final model. To differentiate patients with or without GS upgrading, a cut-off value was derived from the area under the receiver operating characteristic (AUROC) curve of the score, based on the highest Youden index. RESULTS: Rate of GS upgrading was 56.7%. In multivariate analysis, length of cancer per core > 5mm (OR=2.938; p 15 ng/ml (OR=2.365; p = 0.01), age > 70 (OR=1.746 ; p=0.016), number of biopsy cores > 12 (OR=0.696; p=0.041) and prostate weight > 50g (OR=0.656 ; CI ; p<0.007) were independent predictive factors of GS upgrading. A score weighted according b coefficient and ranged between -2 and 5 was attributed to each independent predictive factor. Total score ranging between -4 and 12 was established by summing all points. A cut-off of 2 was correlated to the greatest Youden Index and therefore selected to discriminate patients at risk of GS upgrading. In the development cohort, the accuracy of predictive score was 63.7% and the positive predictive value was 71.2%. Results were confirmed in the external validation cohort with an accuracy of 63.9 % and a positive predictive value of 69.8%. CONCLUSIONS: Probability for biopsy GS≤6 PCa to be GS>6 after RP was 71,3% when the predictive score was > 2. Such a tool might be helpful to screen patients with initial low grade cancer harboring occult high grade disease and to adapt management.
Biopsy Gleason score ≤ 6. How to predict final pathological specimen Gleason score? Eur Urol Suppl 2013;12;e716
Seisen T.1, Roudot Thoraval F.2, Bosset P.O.1, Campeggi A.1, Allory Y.3, Vordos D.1, Hoznek A.1, Abbou C-C.1, De La Taille A.1, Salomon L.1 1
Henri Mondor, Dept. of Urology, Creteil, France, 2Henri Mondor, Dept. of Public Health, Creteil, France, 3Henri
Mondor, Dept. of Anatomopathology, Creteil, France INTRODUCTION & OBJECTIVES: Gleason score (GS) is commonly used with clinical stage and PSA level to assess evolution risk of prostate cancer (PCa) and select adequate management. However, biopsy and final pathological specimen GS are inconstantly correlated to each other. Therefore, we aimed to develop and validate a new predictive score to screen patients with biopsy GS ≤ 6 at risk of GS upgrading. MATERIAL & METHODS: Clinical and pathological data of 1179 patients managed with RP for a biopsy GS ≤ 6 PCa between 1998 and 2012 were collected. Inclusion criteria were biopsy GS ≤ 6, clinical stage ≤ T2b and pre-operative PSA ≤ 20 ng/ml. The population study was randomly split into a development (n=822) and a validation (n =357) group. In the development cohort, univariate analysis first identified factors related to GS upgrading. Then, predictive factors of GS upgrading were tested in a forward stepwise logistic regression model. A prognostic score was established using the independent variables and weighted according to the estimated b regression coefficient of the final model. To differentiate patients with or without GS upgrading, a cut-off value was derived from the area under the receiver operating characteristic (AUROC) curve of the score, based on the highest Youden index. RESULTS: Rate of GS upgrading was 56.7%. In multivariate analysis, length of cancer per core > 5mm (OR=2.938; p 15 ng/ml (OR=2.365; p = 0.01), age > 70 (OR=1.746 ; p=0.016), number of biopsy cores > 12 (OR=0.696; p=0.041) and prostate weight > 50g (OR=0.656 ; CI ; p<0.007) were independent predictive factors of GS upgrading. A score weighted according b coefficient and ranged between -2 and 5 was attributed to each independent predictive factor. Total score ranging between -4 and 12 was established by summing all points. A cut-off of 2 was correlated to the greatest Youden Index and therefore selected to discriminate patients at risk of GS upgrading. In the development cohort, the accuracy of predictive score was 63.7% and the positive predictive value was 71.2%. Results were confirmed in the external validation cohort with an accuracy of 63.9 % and a positive predictive value of 69.8%. CONCLUSIONS: Probability for biopsy GS≤6 PCa to be GS>6 after RP was 71,3% when the predictive score was > 2. Such a tool might be helpful to screen patients with initial low grade cancer harboring occult high grade disease and to adapt management.