REVIEW   Free access

Minerva Urology and Nephrology 2021 February;73(1):42-9

DOI: 10.23736/S2724-6051.20.03778-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

A systematic review and meta-analysis of prognostic impact of different Gleason patterns in ISUP grade group 4

Keiichiro MORI ^{1, 2} ✉, Noriyoshi MIURA ^{1, 3}, Eva COMPERAT ⁴, Sven NIKLES ⁵, Karl H. PANG ⁶, Vincent MISRAI ⁷, Juan GOMEZ RIVAS ^{8, 9}, Rocco PAPALIA ¹⁰, Shahrokh F. SHARIAT ^{1, 11, 12, 13, 14, 15, 16, 17}, Francesco ESPERTO ^{9, 10, 18}, Benjamin PRADERE ^{1, 18, 19}

¹ Department of Urology, Medical University of Vienna, Vienna, Austria; ² Department of Urology, The Jikei University School of Medicine, Tokyo, Japan; ³ Department of Urology, Ehime University Graduate School of Medicine, Ehime, Japan; ⁴ Department of Pathology, Tenon Hospital, Sorbonne University, Paris, France; ⁵ Sestre Milosrdnice University Hospital, Zagreb, Croatia; ⁶ Unit of Academic Urology, University of Sheffield, Sheffield, UK; ⁷ Department of Urology, Clinique Pasteur, Toulouse, France; ⁸ Department of Urology, La Paz University Hospital, Madrid, Spain; ⁹ European Society of Residents in Urology (ESRU), Arnhem, the Netherlands; ¹⁰ Department of Urology, Campus Biomedico University Hospital, Rome, Italy; ¹¹ Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; ¹² Department of Urology, Weill Cornell Medical College, New York, NY, USA; ¹³ Department of Urology, University of Texas Southwestern, Dallas, TX, USA; ¹⁴ Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; ¹⁵ Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; ¹⁶ Department of Urology, University of Jordan, Amman, Jordan; ¹⁷ European Association of Urology Research Foundation, Arnhem, the Netherlands; ¹⁸ EAU Young Urologist Office (YOU), Arnhem, the Netherlands; ¹⁹ Department of Urology, CHRU Tours, PRES Centre Val de Loire, François Rabelais de Tours University, Tours, France

INTRODUCTION: This systematic review and meta-analysis was conducted to assess the prognostic differences between different Gleason patterns in patients with prostate cancer (PC) within Internal Society of Urological Pathology (ISUP) grade group 4 (GG 4).
EVIDENCE ACQUISITION: PUBMED and Scopus databases were searched for articles published prior to December 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared overall survival (OS), cancer-specific survival (CSS), and surgical pathological outcomes in PC patients categorized as ISUP GG 4 (Gleason Score [GS] 4+4 vs. GS 3+5 or GS 5+3). Formal meta-analyses were performed for these outcomes.
EVIDENCE SYNTHESIS: Ten studies with 42,041 patients were eligible for the systematic review and eight studies with 36,250 patients for meta-analysis. The treatment type of included study was three surgery and three radiotherapy. The other four studies included many kinds of treatments such as surgery, radiotherapy, androgen deprivation therapy, and chemotherapy. GS 4+4 was significantly associated with better OS (pooled hazard ratio (HR): 0.52, 95% confidential interval (CI): 0.29-0.91) than GS 3+5 or GS 5+3. Positive surgical margin rates were significantly lower with GS 4+4 than GS 3+5 and GS 5+3 (odds ratio [OR] 0.70/95% CI 0.64-0.77 and OR 0.70/95% CI 0.56-0.87, respectively). In contrast, different Gleason patterns in ISUP GG 4 were not significantly associated with CSS (pooled HR: 0.77, 95% CI: 0.56-1.06).
CONCLUSIONS: GS 4+4 in patients with PC was associated with better OS and positive surgical margin rates. It seems likely that there is heterogeneity within ISUP GG 4. However, caution should be exercised in interpreting the conclusions drawn from this study, given the limitations of the study, which include the heterogeneity of the population of interest and the retrospective nature of the primary data evaluated.

KEY WORDS: Prostatic neoplasms; Neoplasm grading; Meta-analysis