A Nomogram For Analyzing Prognostic Features In Patients With Gleason 8 Prostate Tumor

Objective:Prostate cancer(CaP),as the most common genital neoplasm,holds the highest incidence among men in the majority of the world.Gleason grading is one of the most important predictors of prognosis for patients with cancer and to date more than 40 grading systems have been proposed for prostate carcinoma.However,few researches focus on clinical features in different subgroup of Gleason score 8 patients.Therefore,to better under its association and investigate the survival prognostic features in Gleason score 8 patients,our research has become more significantly important.Methods:We queried the Surveillance,Epidemiology,and End Results Program Database for the prostate cancer patients with Gleason score 8 adenocarcinoma on biopsy.A total of 36045 patients were selected from 2004 January to 2014 December.Kaplane-Meier OS estimates as well as univariate and multivariate Cox proportional hazards regression analyses were performed.According to the regression equation,R software is used to construct nomogram.C-index and calibration curve are calculated by Bootstrap self-sampling and internal verification.Results:(1)In the subgroup of Gleason score 8 patients,respectively 3989(GS=3+5),30811(GS=4+4)and 1245(GS=5+3)were included.Median age of the entire cohort was 68 years(inter quartile range(IQR):62–74)and median Prostate specific antigen concentration 88ng/ml(5.7~18ng/ml);The majority of patients were white(76.0%)and married(66.7%);Additionally,the majority of patients were identified clinical T2(42.9%)and poorly histological grade(97.3%);Moreover,the patients were more likely to undergo radical prostatectomy(30.1%)and less likely to receive combination therapy as primary treatment(13.5%).(2)Our findings exhibited that many factors were related with the GS=8 patients survival,including age,race,marital status,PSA concentration,clinical T-classification,the histological differentiated grade and different treatments.Among them,the yellow race was the protective prognostic factor(HR=0.643,95%CI,0.553~0.747;P<0.001),but age(HR=1.052,95%CI,1.047~1.056;P<0.001),single status(HR=1.771,95%CI,1.581~1.963;P<0.001)and PSA concentration(HR=1.001,95%CI,1.000~1.001;P < 0.001)were hazardous factors.Moreover,compared with clinical T1 a,T4 patients showed the worst survival(HR=1.805,95%CI=1.293~2.519;p=0.001).(3)On Kaplane-Meier analysis,we found that Five-year overall survival was79.1%,82.3%,and 77.9% for GS=3+5,GS=4+4 and GS=5+3.The median survival time was showed 71.42±0.18 months,73.55±0.41 months and 69.93±0.81 months for GS=3+5,GS=4+4 and GS=5+3.(4)We have then established a nomogram model.C-index is 0.804,has been indicated good discrimination.The calibration curve is fitting unit-slope straight line,suggesting high accuracy.Conclusion:(1)The factors were related with the GS=8 patients survival,including age,race,marital status,PSA concentration,clinical T,the histological grade and treatments.(2)The patients with Gleason=4+4 have showed better survival than GS=5+3and GS=3+5.(3)A nomogram model was established for predicting 3-years and 5-years functional prognosis of Gleason 8 prostate cancer based on the hazardous factors.