Page 311 - An Evidence Review of Active Surveillance in Men With Localized Prostate Cancer

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Appendix Table C1.12. Gofrit 2007 , systematic review of the effect of histopathologic grading changes
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Author Year [PMID] Gofrit 2007 [17997434]
Design A structured review of studies of the “Will Rogers” phenomenon in urologic oncology
Population All urologic cancer patients (separate results reported for prostate cancer)
Exposure Histological reclassification (temporal change in guidelines or prevailing norms for diagnosing, staging or grading the
histology of prostate cancer)
Results Medline (15 cited studies)
As reported by the authors:
1. In prostate cancer the Will Rogers phenomenon is the result of the late 1990s acceptance that Gleason scores 2-4
should not be assigned on prostate biopsy.
2. Consequently grade inflation occurred and current readings are almost 1 Gleason grade higher compared to past
readings of the same biopsy.
3. The result is an illusion of improvement in grade adjusted prognosis.
Comments As noted by the authors:
1. Comparison of contemporary results to historical controls may be biased by the Will Rogers phenomenon.
2. Ignoring the possibility of stage or grade reclassification may lead to erroneous conclusions.
AMSTAR items
A priori design? N
Two independent reviewers? N
Comprehensive literature search? N
All publication types and languages N
included?
Included and excluded studies N
listed?
Study characteristics provided? N
Study quality assessment N
performed?
Study quality appropriately used in N
analysis?
Appropriate statistical synthesis? NA
Publication bias assessed? N
Conflicts of interest stated? Y
N = no; NA = not applicable; PMID = PubMed identification number; Y = yes.

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