Extent and predictors of grade upgrading and downgrading in an Australian cohort according to the new prostate cancer grade groupings

作     者：Kerri Beckmann Michael O’Callaghan Andrew Vincent Penelope Cohen Martin Borg David Roder Sue Evans Jeremy Millar Kim Moretti 

作者机构：Cancer Research InstituteSchool of Health SciencesUniversity of South AustraliaAdelaideAustralia School of Cancer and Pharmaceutical SciencesKing’s College LondonLondonUK Flinders Medical CentreUrology UnitAdelaideAustralia School of MedicineUniversity of AdelaideAdelaideAustralia SA PathologyHealth SAAdelaideSouth AustraliaAustralia Genesis CareUniversity of AdelaideAdelaideAustralia Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia 

出 版 物：《Asian Journal of Urology》 (亚洲泌尿外科杂志（英文）)

年 卷 期：2019年第6卷第4期

页      面：321-329页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：This project was funded by the Movember Foundation as part of their Australian and New Zealand prostate cancer outcomes registry initiative(PCOR-ANZ)which aims to develop a binational clinical registry for outcomes monitoring and research to inform practice and improve outcomes for men with prostate cancer.Dr.Beckmann is supported by an NHMRC Early Career Researcher Fellowship 

主　　题：Prostate cancer Grade misclassification Biopsy Radical prostatectomy Pathology 

摘      要：Object:To determine the extent and impact of upgrading and downgrading among men who underwent radical prostatectomy(RP)according to new grade groupings and to identify predictors of upgrading from biopsy grade Group Ⅰ and Ⅱ,and downgrading to grade Group I,in a community ***:Study participants included 2279 men with non-metastatic prostate cancer diagnosed 2006-2015 who underwent prostatectomy,from the multi-institutional South Australia Prostate Cancer Clinical Outcomes Collaborative *** of up-or down-grading was assessed by comparing biopsy and prostatectomy grade *** of biochemical recurrence(BCR)with upgrading was assessed using multivariable competing risk *** logistic regression was used to identify pre-treatment predictors of upgrading from grade Groups Ⅰ and Ⅱ,and risk group reclassification among men with low risk ***:Upgrading occurred in 35%of cases,while downgrading occurred in 13%of *** percent with grade Group I disease were upgraded following *** from grade Group I was associated with greater risk of BCR compared with concordant grading(Hazard ratio:3.1,95%confidence interval:1.7-6.0).Older age,higher prostate-specific antigen levels(PSA),fewer biopsy cores,higher number of positive cores and more recent diagnosis predicted upgrading from grade Group Ⅰ,while higher PSA and clinical stage predicted upgrading from grade Group Ⅱ.No clinical risk factors for reclassification were ***:Biopsy sampling errors may play an important role in upgrading from grade Group *** clinical assessment of grade is needed to encourage greater uptake of active surveillance.