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Interlaboratory Gleason grading variation affects treatment: a Dutch historic cohort study in 30 509 patients with prostate cancer
  1. Rachel N Flach1,
  2. Carmen van Dooijeweert2,
  3. Katja K H Aben3,4,
  4. Britt B M Suelmann5,
  5. Peter-Paul M Willemse1,
  6. Paul J van Diest2,
  7. Richard P Meijer1
  1. 1Department of Oncological Urology, UMC Utrecht, Utrecht, The Netherlands
  2. 2Department of Pathology, UMC Utrecht, Utrecht, The Netherlands
  3. 3Department of Research & Development, Netherlands Comprehensive Cancer Centre, Utrecht, The Netherlands
  4. 4Radboud Institute for Health Sciences, Radboud UMC, Nijmegen, Gelderland, The Netherlands
  5. 5Department of Medical Oncology, UMC Utrecht, Utrecht, The Netherlands
  1. Correspondence to Professor Paul J van Diest; p.j.vandiest{at}umcutrecht.nl

Abstract

Aim Substantial variation in Gleason grading (GG) of prostate cancer (PCa) exists between Dutch pathology laboratories. This study investigates its impact on treatment strategies.

Methods Pathology reports of prostate needle biopsies and clinical data of patients with PCa diagnosed between 2017 and 2019 were retrieved from the Dutch nationwide network and registry of histopathology and cytopathology and The Netherlands Cancer Registry. We investigated the impact of grading variation on treatment strategy for patients whose grade was decisive in treatment choice. First, we evaluated the effect of grading practice (low, average or high grading) on active treatment (AT) versus active surveillance in patients with prostate-specific antigen (PSA) <10 ng/mL and cT1c/cT2a disease. Second, we assessed the association of grading practice with performance of pelvic lymph node dissection (PLND) in patients with PSA 10–20 ng/mL or cT2b disease. We used multivariable logistic regression to analyse the relation between laboratories’ grading practices and AT or PLND.

Results We included 30 509 patients. GG was decisive in treatment strategy for 11 925 patients (39%). AT was performed significantly less often in patients diagnosed by laboratories that graded lower than average (OR=0.77, 95% CI 0.68 to 0.88). Conversely, patients received AT significantly more often when diagnosed in high-grading laboratories versus average-grading laboratories (OR=1.21, 95% CI 1.03 to1.43). PLND was performed significantly less often in patients diagnosed by low-grading versus average-grading laboratories (OR=0.66, 95% CI 0.48 to 0.90).

Conclusion Our study shows that the odds that a patient undergoes AT or PLND, depends on laboratories’ grading practices in a substantial number of patients. This likely influences patient prognosis and outcome, necessitating standardisation of GG to prevent suboptimal patient outcome.

  • prostate
  • urologic neoplasms
  • pathology, surgical

Data availability statement

Data may be obtained from a third party and are not publicly available. Data are available upon reasonable request at PALGA and the NCR.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Data are available upon reasonable request at PALGA and the NCR.

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Footnotes

  • Handling editor Dhirendra Govender.

  • Contributors RNF: conceptualisation, methodology, formal analysis, investigation, data curation, writing original draft, visualisation. CvD: conceptualisation, writing—review and editing. KKHA: methodology, resources, writing—review and editing. BBMS: conceptualisation, writing—review and editing, funding acquisition. P-PMW: conceptualisation, writing—review and editing. PJvD: writing—review and editing, funding acquisition, guarantor. RPM: conceptualisation, writing—review and editing, funding acquisition, supervision.

  • Funding This research was funded by Quality Foundation of the Dutch Association of Medical Specialists (SKMS), Astellas Pharma BV and Pfizer BV. The funding sources had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests PJvD received research grant from Quality Foundation of the Dutch Associaton of Medical Specialists (SKMS). RPM received research grant from Astellas Pharma B.V. BBMS received research grant from Pfizer BV. All other authors declare no conflicts of interests.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.