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Validation of the prognostic grouping of the seventh edition of the tumor‐nodes‐metastasis classification using a large‐scale prospective cohort study database of prostate cancer treated with primary androgen deprivation therapy
Author(s) -
Kimura Tomokazu,
Onozawa Mizuki,
Miyazaki Jun,
Kawai Koji,
Nishiyama Hiroyuki,
Hinotsu Shiro,
Akaza Hideyuki
Publication year - 2013
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12064
Subject(s) - medicine , prostate cancer , concordance , androgen deprivation therapy , oncology , prostate specific antigen , metastasis , survival analysis , prostate , cohort , stage (stratigraphy) , cancer , paleontology , biology
Objective In the TNM seventh edition, a prognostic grouping for prostate cancer incorporating prostate‐specific antigen and G leason score was advocated. The present study was carried out to evaluate and validate prognostic grouping in prostate cancer patients. Methods The 15 259 study patients treated with primary androgen deprivation therapy were enrolled in the Japan Study Group of Prostate Cancer. Overall survival was stratified by tumor–nodes–metastasis, G leason score and prostate‐specific antigen, and extensively analyzed. The accuracy of grouping systems was evaluated by the concordance index. Results The 5‐year overall survival in prognostic grouping‐ I , IIA , IIB , III and IV was 90.0%, 88.3%, 84.8%, 80.6% and 57.1%, respectively. When considering subgroup stratification, the 5‐year overall survival of subgroups prognostic grouping ‐IIA , IIB , III and IV was 80.9∼90.5%, 75.4∼91.8%, 75.7∼89.0% and 46.9∼86.2%, respectively. When prognostic grouping ‐IIB was subclassified into IIB 1 (except IIB 2) and IIB 2 ( T 1–2b, prostate‐specific antigen >20, G leason score ≥8, and T 2c, G leason score ≥8), the 5‐year overall survival of IIB 2 was significantly lower than that of IIB 1 (79.4% and 87.3%, P < 0.0001). Also, when prognostic grouping ‐IV was subclassified into IV 1 (except IV 2) and IV 2 ( M 1, prostate‐specific antigen >100 or G leason score ≥8), the 5‐year overall survival of prognostic grouping‐ IV 1 was superior to that of IV 2 (72.9% and 49.5%, P < 0.0001). Prognostic groupings were reclassified into modified prognostic groupings, divided into modified prognostic grouping‐ A (prognostic grouping‐ I , IIA , and IIB 1), modified prognostic grouping‐ B (prognostic grouping‐ IIB 2 and III ), modified prognostic grouping‐ C (prognostic grouping‐ IV 1) and modified prognostic grouping‐ D (prognostic grouping‐ IV 2). The concordance index of prognostic grouping and modified prognostic grouping for overall survival was 0.670 and 0.685, respectively. Conclusion Prognostic grouping could stratify the prognosis of prostate cancer patients. However, there is considerable variation among the prognostic grouping subgroups. Thus, the use of a modified prognostic grouping for patients treated with primary androgen deprivation therapy is advisable.