EURURO Vol. 71 No. 5

Platinum Priority – Brief Correspondence

Editorial by Jonathan I. Epstein on pp. 764–765 of this issue

Validation of a Contemporary Five-tiered Gleason Grade

Grouping Using Population-based Data

Jianming He

a , b ,

Peter C. Albertsen

c ,

Dirk Moore

a , d ,

David Rotter

d ,

Kitaw Demissie

a ,

Grace Lu-Yao

e , f , *

The School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, USA;

Janssen Global Services LLC, Raritan, NJ, USA;

Department of

Surgery (Urology), University of Connecticut Health Center, Farmington, CT, USA;

The Cancer Institute of New Jersey, Rutgers, The State University of

New Jersey, New Brunswick, NJ, USA;

Department of Medical Oncology, Sidney Kimmel Medical College and Jefferson College of Population Health,

Thomas Jefferson University, Philadelphia, PA, USA;

Sidney Kimmel Cancer Center at Jefferson, Philadelphia, PA, USA

Clinicians have relied on the Gleason grading system since it

was introduced in 1974

[1] .

Gleason originally described

nine patterns of glandular growth that were consolidated

into five grades in a classic teaching diagram. The Gleason

score is the sum of the primary and secondary grades. The

system was validated by Veterans Administration Cooper-

ative Urological Research Group studies on prostate cancer

[1] .

Over the past four decades the Gleason grading system

has consistently proven to be the most powerful predictor

E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) 7 6 0 – 7 6 3

available at

www.scienced irect.com

journal homepage:

www.europeanurology.com

Article info

Article history:

Accepted November 24, 2016

Associate Editor:

James Catto

Keywords:

Gleason score

Prostate cancer

Population-based study

Abstract

This population-based study assesses whether a proposed five-tiered Gleason grade

grouping (GGG) system predicts prostate cancer–specific mortality (PCSM). Using the

Surveillance, Epidemiology, and End Results (SEER) database, we identified

331 320 prostate cancer patients who had primary and secondary Gleason patterns

diagnosed between January 2006 and December 2012. We used the Fine and Gray

proportional hazards model for subdistributions and the corresponding cumulative

incidence to quantify the risk of PCSM. We found that the risk of PCSM approximately

doubled with each GGG increase. Among men who underwent radical prostatectomy

and using GGG1 (Gleason score 6) as the reference group, the adjusted hazard ratio for

PCSMwas 1.13 (95% confidence interval [CI] 0.83–1.54) for GGG2, 1.87 (95% CI 1.33–2.65)

for GGG3, 5.03 (95% CI 3.59–7.06) for GGG4, and 10.92 (CI 8.03-14.84) for GGG5. Similar

patterns were observed regardless of the type of primary cancer treatment received or

clinical stage. In summary, our study, with large, racially diverse populations that reflect

real world experiences, demonstrates that the new five-tiered GGG systempredicts PCSM

well regardless of treatment received or clinical stage at diagnosis.

Patient summary:

In this report we examined prostate cancer mortality using the new

five-tiered cancer grading system using data for a large US population. We found that the

new five-tiered cancer grading system can predict prostate cancer–specific mortality

well, regardless of the type of primary cancer treatment and clinical stage. We conclude

that this new five-tiered cancer grading system is useful in guiding treatment decisions.

* Corresponding author. Department of Medical Oncology, Sidney Kimmel Medical College, Thomas

Jefferson University, 233 South 10th Street, Philadelphia, PA 19107, USA. Tel. +1 215 5037970.

E-mail address:

grace.luyao@jefferson.edu

(G. Lu-Yao).

http://dx.doi.org/10.1016/j.eururo.2016.11.031

0302-2838/