1637 IMPACT OF THE 2005 ISUP GLEASON SCORING SYSTEM MODIFICATION ON OUR ABILITY TO PREDICT EXTRAPROSTATIC EXTENSION
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Résumé
You have accessJournal of UrologyProstate Cancer: Localized VIII1 Apr 20121637 IMPACT OF THE 2005 ISUP GLEASON SCORING SYSTEM MODIFICATION ON OUR ABILITY TO PREDICT EXTRAPROSTATIC EXTENSION Carlos Morales, David Margel, Stanley Yap, Michael Nesbitt, Andrew Evans, John Trachtenberg, and Neil Fleshner Carlos MoralesCarlos Morales Toronto, Canada More articles by this author , David MargelDavid Margel Toronto, Canada More articles by this author , Stanley YapStanley Yap Toronto, Canada More articles by this author , Michael NesbittMichael Nesbitt Toronto, Canada More articles by this author , Andrew EvansAndrew Evans Toronto, Canada More articles by this author , John TrachtenbergJohn Trachtenberg Toronto, Canada More articles by this author , and Neil FleshnerNeil Fleshner Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1454AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Many physicians rely on predictive models such nomograms to provide advice to patients with prostate cancer on best treatment options. In 2005, the International Society of Urological Pathology (ISUP) made the first major revision of the Gleason scoring system since its inception. The aim of our study is to determine whether these modifications impact the relationship between biopsy staging and pathologic findings after radical prostatectomy (RP), as well as to assess the accuracy of Kattan nomograms using the modern scoring system. METHODS We correlated needle biopsy findings with RP pathologic findings in 330 consecutive patients before (years 2002 to 2004) and 690 patients after (years 2008 to 2010) the 2005 ISUP Gleason score modification. All pathological specimens were reviewed by expert uropathologists at our institution. Analysis was stratified across four Gleason grading groups: 6, 7 (3+4), 7 (4+3) and 8 to 10. Other analyzed variables were correlated within each cohort and included tumor volume, surgical margin status, and pathological T Stage. Finally, the Kattan nomogram probability of extraprostatic extension (ECE) was calculated for each patient and the accuracy of the nomogram was compared between the two cohorts using receiver operating characteristic (ROC) curves and area under the curve (AUC) analysis. RESULTS Overall agreement in Gleason score between biopsy and RP specimens was 67% and 58% for the old and new cohort, respectively (p=0.08). In addition we found a significantly higher rates of downgrading between biopsy and RP specimen in the new cohort (14%) compared to the old cohort (6.5%), p= 0.02. Gleason 7 (3+4) disease identified on biopsy was associated with lower pathologic T Stage when utilizing the new staging system. Among patients with Gleason 7 (3+4) disease on biopsy, rates of pathological T3b disease decreased from 18.5% in the old cohort to 5.9% in the new cohort, while rates of T2 disease increased from 50% to 60.5% (p=0.03). Finally, The older staging system provided better accuracy in predicting ECE using the Kattan nomogram. AUC for the older staging system was 0.78 (95%CI is 0.7-0.84) compared 0.7 (95%CI is 0.67-0.73) in the modified 2005 grading system, p=0.04. CONCLUSIONS We report a decreased concordance between biopsy specimen and final RP pathology when utilizing the new scoring system, attributable to a significant downgrading. The new grading system also demonstrates a decreased ability to predict ECE using Kattan nomograms. These findings need to be considered when risk-stratifying and treament decisions are made. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e661 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carlos Morales Toronto, Canada More articles by this author David Margel Toronto, Canada More articles by this author Stanley Yap Toronto, Canada More articles by this author Michael Nesbitt Toronto, Canada More articles by this author Andrew Evans Toronto, Canada More articles by this author John Trachtenberg Toronto, Canada More articles by this author Neil Fleshner Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,041 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,017 | 0,004 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».