• 2019-07
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  • br Conflicts of interest br Author contribution statement


    Conflicts of interest
    Author contribution statement
    Acknowledgments Fundingwas provided by Alex’s Lemonade Stand Foundation.
    Introduction The TNM-Staging System (“Tumor, node and metastasis”) of the “International Union for Cancer Central (UICC)” [1] and the „American Joint Committee on Cancer “(AJCC) [2] are the most frequently used classification systems for malignant tumors. These systems describe the anatomical spread of the primary tumor (T) and the presence of NSC232003 node (N) or distant metastases (M). While the clinical (c) TNM classification mainly relates to the results of physical examination or imaging, the pathological (p) TNM classification is based on the findings of the histological examination after surgery [3]. With this information, the prognosis can be estimated, a stage related therapy can be initiated, and treatment or study results can be compared between individual study centers [4]. For prostate cancer, the cancer with the highest incidence in Europe and the USA [5,6], the TNM system was introduced in 1992 [7]. It was revised several times in the following years and adapted to the needs of clinicians and pathologists [[8], [9], [10], [11]]. The latest version of the UICC is available in the 8th edition, it was published in 2017 and should be used from January 1, 2017 [1]. The updated 8th edition of the AJCC was implemented on January 1, 2018 (Table 1a) [12]. While the cT category of both staging systems is identical, localized prostate cancer can be divided into two stages (S I, S II) according to the UICC based on the TNM system. The AJCC additionally provides prognostic stage groups (PSG) by incorporating Prostate Specific Antigen (PSA) and World Health Organization (WHO) grade group or Gleason Score into six groups (PSG I, PSG IIA, PSG IIB, PSG IIC, PSG IIIA, PSG IIIC; while PSG IIIB includes only locally advanced prostate cancer; Table 1b) [2,3]. In the present study, we examined the predictive value of the cT category, the stage, and the prognostic stage groups according to the TNM classification for an organ confined disease (pT≤2), a favorable WHO grade group (≤2) or favorable Gleason Score (≤7a), and the biochemical free survival (BFS) after radical prostatectomy (RP) in a cohort of patients with clinical localized prostate cancer in a prospective German, multicenter, health service research study (HAROW) [13]. The aim of the study is to evaluate these grouping systems, whether α-Amanitin are useful to help clinicians in the pre-surgical setting for the prediction of the oncological outcome after RP, and thus, for a better advise of their patients.
    Material and methods
    Discussion As a consequence of PSA testing, the vast majority (> 80%) of prostate cancer present in a clinically localized stage with a nonpalpable disease and are classified in the cT1c category [6]. To further enhance the value of clinical staging, a prognostic grouping was evolved by the UICC and AJCC in the 7th edition of the TNM classification by incorporating WHO grade group/Gleason score and PSA in the stage [3,10] in which localized prostate cancer was divided into three prognostic groups (I, IIA, IIB). This classification system was identical to the D’Amico classification, the most commonly used classification for localized Prostate cancer. It was originally developed for patients receiving RT [15], and has also been validated for RP in several studies [16,17]. Based on this classification, localized prostate cancer is subdivided in low (≤ cT2a and PSA≤ 10 ng/mL and WHO grade 1/Gleason Score 6), intermediate (cT2b or PSA ≥ 10–20 ng/mL or WHO grade 2–3/Gleason Score 7), or high risk (cT2c or PSA ≥ 20 ng/mL or WHO grade ≥ 4/Gleason Score ≥ 8), corresponding to prognostic group I, IIA and IIB, respectively. In the 8th edition, the UICC maintained only the stage based on the cT category, whereas the prognostic grouping system was continued only by the AJCC in terms of the prognostic stage groups (PSG). It received some transformations, in which the distribution of selected organ-confined disease in PSG III which was originally only for locally advanced cancers, was a major change [12].