Gleason grading of prostate cancer is an important prognostic factor but suffers from poor reproducibility, particularly among non-subspecialist pathologists. Although artificial intelligence (A.I.) tools have demonstrated Gleason grading on-par with expert pathologists, it remains an open question whether A.I. grading translates to better prognostication. In this study, we developed a system to predict prostate-cancer specific mortality via A.I.-based Gleason grading and subsequently evaluated its ability to risk-stratify patients on an independent retrospective cohort of 2,807 prostatectomy cases from a single European center with 5-25 years of follow-up (median: 13, interquartile range 9-17). The A.I.'s risk scores produced a C-index of 0.84 (95%CI 0.80-0.87) for prostate cancer-specific mortality. Upon discretizing these risk scores into risk groups analogous to pathologist Grade Groups (GG), the A.I. had a C-index of 0.82 (95%CI 0.78-0.85). On the subset of cases with a GG in the original pathology report (n=1,517), the A.I.'s C-indices were 0.87 and 0.85 for continuous and discrete grading, respectively, compared to 0.79 (95%CI 0.71-0.86) for GG obtained from the reports. These represent improvements of 0.08 (95%CI 0.01-0.15) and 0.07 (95%CI 0.00-0.14) respectively. Our results suggest that A.I.-based Gleason grading can lead to effective risk-stratification and warrants further evaluation for improving disease management.
@article{arxiv.2012.05197,
title = {Predicting Prostate Cancer-Specific Mortality with A.I.-based Gleason Grading},
author = {Ellery Wulczyn and Kunal Nagpal and Matthew Symonds and Melissa Moran and Markus Plass and Robert Reihs and Farah Nader and Fraser Tan and Yuannan Cai and Trissia Brown and Isabelle Flament-Auvigne and Mahul B. Amin and Martin C. Stumpe and Heimo Muller and Peter Regitnig and Andreas Holzinger and Greg S. Corrado and Lily H. Peng and Po-Hsuan Cameron Chen and David F. Steiner and Kurt Zatloukal and Yun Liu and Craig H. Mermel},
journal= {arXiv preprint arXiv:2012.05197},
year = {2022}
}