Prognostic Differences in ISUP Grade Group 4: a Systematic Review and Meta-Analysis.

Authors:
Luke Collins
Luke Collins
The University of Nottingham
United Kingdom
Penelope Cohen
Penelope Cohen
Royal Adelaide Hospital
Jared M Campbell
Jared M Campbell
School of Paediatrics and Reproductive Health
Australia

Pathol Oncol Res 2019 Mar 14. Epub 2019 Mar 14.

Urology Unit, Flinders Medical Centre, Bedford Park, Australia.

The ISUP (Internal Society of Urologic Pathology) recently adopted a five-tiered prognostication system. There is evidence to suggest that the ISUP grade group 4 is a heterogeneous entity regarding prognosis. Our aim was to systematically examine the existing evidence to determine if outcome differences exist within the ISUP grade group 4. A systematic search of the literature for all studies examining the heterogeneity of the ISUP grade group 4 was conducted. Available studies were combined with meta-analysis to evaluate prognostic differences within the ISUP grade group 4 measured by all-cause mortality (ACM) and the prostate cancer-specific mortality (PCSM). Eight studies were identified and utilised a variety of outcome measures to answer the question of heterogeneity within the ISUP grade group 4. Four of these studies examined prognosis using both ACM and PCSM. These were combined into a meta-analysis. The combined group of 5 + 3/3 + 5 had statistically significant higher ACM (hazard ratio [HR] 1.23, 95% confidence internal [Cl] 1.08-1.41) when compared to the 4 + 4 group. There was no difference in the PCSM between the two groups (HR 1.34, 95% CI 0.89-2.01). However, heterogeneity was high for this analysis secondary to a range of methodological differences. Our meta-analysis showed that Gleason grade 3 + 5/5 + 3 had higher ACM than Gleason grade group 4 + 4. Measures of PCSM were statistically insignificant, although heterogeneity was high. Evidence suggests that heterogeneity is likely, although inconclusive. Further studies with consistent methodologies are required to answer this question.

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http://dx.doi.org/10.1007/s12253-019-00632-1DOI Listing
March 2019

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References

(Supplied by CrossRef)
Article in J Urol
MG Sanda et al.
J Urol 2017
Article in J Urol
MG Sanda et al.
J Urol 2018
Article in Am J Surg Pathol
JI Epstein et al.
Am J Surg Pathol 2005
Article in Eur Urol
JI Epstein et al.
Eur Urol 2016
Article in Int J Radiat Oncol Biol Phys
MJ Burdick et al.
Int J Radiat Oncol Biol Phys 2009
Article in Urology
DE Kang et al.
Urology 2007
Article in Int J Radiat Oncol Biol Phys
BF Koontz et al.
Int J Radiat Oncol Biol Phys 2012
Article in J Clin Oncol
JR Stark et al.
J Clin Oncol 2009
Article in J Urol
MK Tollefson et al.
J Urol 2006
Article in J Urol
JL Wright et al.
J Urol 2009
Article in Eur Urol
MA Huynh et al.
Eur Urol 2016

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