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Gleason 5+4 Has Worse Oncological and Pathological Outcomes Compared with Gleason 4+5: Significance of Gleason 5 Pattern

 Sey Kiat Lim  ;  Kwang Hyun Kim  ;  Tae-Young Shin  ;  Byung Ha Chung  ;  Sung Joon Hong  ;  Young Deuk Choi  ;  Koon Ho Rha 
 ANNALS OF SURGICAL ONCOLOGY, Vol.20(9) : 3127-3132, 2013 
Journal Title
Issue Date
Aged ; Follow-Up Studies ; Humans ; Male ; Neoplasm Grading ; Neoplasm Recurrence, Local/mortality* ; Neoplasm Recurrence, Local/pathology ; Neoplasm Recurrence, Local/surgery ; Prognosis ; Prospective Studies ; Prostatectomy/mortality* ; Prostatic Neoplasms/mortality* ; Prostatic Neoplasms/pathology ; Prostatic Neoplasms/surgery ; Robotics* ; Survival Rate
Lymph Node Involvement ; Radical Prostatectomy ; Oncological Outcome ; Biochemical Failure ; Seminal Vesicle Invasion
Background The purpose of this study was to evaluate the pathological and oncological significance of Gleason (G) 5 pattern in high-grade PCa after robotic-assisted radical prostatectomy (RARP). Materials and Methods From a cohort of 1,046 men, 159 post-RARP patients by a single surgeon with pathological G8 (N = 79) and G9 (N = 80) met our inclusion criteria. G9 cancers were sub-stratified into G4+5 (N = 58) and G5+4 (N = 22). Clinical and pathological outcomes were evaluated with the t test or Mann–Whitney U test for continuous variables and the Pearson χ 2 test for categorical variables. The Kaplan–Meier method was used to estimate the biochemical recurrence-free survival (BCRFS), and survival curves were compared using the log-rank test. Multivariate analysis was performed with Cox regression analysis. Results Baseline characteristics across all subgroups were similar except for number of positive cores on biopsy. There was a trend toward worse pathological and oncological outcomes in G9 cancers when compared with G8, although only tumor volume (TV), extracapsular extension (ECE) of tumor and lymph nodes involvement (LNI) achieved statistical significance. G4+5 PCa were statistically more likely to have ECE and a higher TV than G4+4 although the BCRFS were not significantly different. G5+4 cancers were associated with a significantly higher proportion of patients with LNI and had a statistically significant poorer BCRFS compared with G4+5 patients. Conclusions Oncological and pathological outcomes of G8 were significantly better than G9 and merited distinction between them. G5+4 harbors a much poorer BCRFS compared with G4+5, and hence we suggest considerations for immediate adjuvant treatments.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kwang Hyun(김광현)
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
Shin, Tae Young(신태영)
Lim, Sey Kiat(임세이캣)
Chung, Byung Ha(정병하) ORCID logo https://orcid.org/0000-0001-9817-3660
Choi, Young Deuk(최영득) ORCID logo https://orcid.org/0000-0002-8545-5797
Hong, Sung Joon(홍성준) ORCID logo https://orcid.org/0000-0001-9869-065X
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