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

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Pathology Oncology Research : POR
|March 16, 2019
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Summary

The Internal Society of Urologic Pathology (ISUP) grade group 4 may be heterogeneous. While 5+3/3+5 Gleason scores showed higher all-cause mortality than 4+4, prostate cancer-specific mortality differences were inconclusive, indicating a need for further research.

Keywords:
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Area of Science:

  • Uropathology
  • Oncology
  • Prognostic Biomarkers

Background:

  • The International Society of Urologic Pathology (ISUP) established a five-tiered grading system for prostate cancer prognostication.
  • Emerging evidence suggests potential heterogeneity within ISUP grade group 4, impacting patient outcomes.

Purpose of the Study:

  • To systematically review and meta-analyze existing literature to determine if prognostic differences exist within ISUP grade group 4.
  • To evaluate outcome variations based on specific Gleason score combinations within ISUP grade group 4.

Main Methods:

  • A systematic literature search was performed to identify studies investigating ISUP grade group 4 heterogeneity.
  • Meta-analysis was conducted on four studies reporting all-cause mortality (ACM) and prostate cancer-specific mortality (PCSM).

Main Results:

  • The 5+3/3+5 Gleason score combination demonstrated a statistically significant higher ACM compared to the 4+4 group (HR 1.23, 95% CI 1.08-1.41).
  • No significant difference in PCSM was observed between the 5+3/3+5 and 4+4 groups (HR 1.34, 95% CI 0.89-2.01), though heterogeneity was high.
  • Evidence suggests heterogeneity within ISUP grade group 4, but findings remain inconclusive due to methodological variations.

Conclusions:

  • Prostate cancer patients with Gleason scores 5+3/3+5 within ISUP grade group 4 exhibit higher all-cause mortality than those with 4+4.
  • Further research with standardized methodologies is essential to definitively clarify prognostic differences within ISUP grade group 4.