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Presence of invasive cribriform or intraductal growth at biopsy outperforms percentage grade 4 in predicting outcome of Gleason score 3+4=7 prostate cancer.

在Gleason评分3+4 = 7分的前列腺癌活检标本中浸润性或导管内筛状癌比Gleason4级百分比更有预后意义

Kweldam CF,Kümmerlin IP,Nieboer D,Steyerberg EW,Bangma CH,Incrocci L,van der Kwast TH,Roobol MJ,van Leenders GJ
阅读:1016 Modern PathologyAug 2017; 30 (8): 1046 - 1189:1126-1132 

Abstract

Relative increase of grade 4 and presence of invasive cribriform and/or intraductal carcinoma have individually been associated with adverse outcome of Gleason score 7 (GS 7) prostate cancer. The objective of this study was to investigate the relation of Gleason grade 4 tumor percentage (%GG4) and invasive cribriform and/or intraductal carcinoma in GS 3+4=7 prostate cancer biopsies. We reviewed 1031 prostate cancer biopsies from the European Randomized Study of Screening for Prostate Cancer. In total 370 men had G3+4=7. The relation of invasive cribriform and/or intraductal carcinoma and %GG4 with biochemical recurrence-free survival (BCRFS) after radical prostatectomy (n=146) and radiation therapy (n=195) was analyzed using Cox regression. Invasive cribriform and/or intraductal carcinoma occurred in 7/121 (6%) patients with 1-10% GG4, 29/131 (22%) with 10-25%, and 52/118 (44%) with 25-50% GG4 (P<0.001). In crude analysis, both invasive cribriform and/or intraductal carcinoma (HR 2.72; 95% CI: 1.33-5.95; P=0.006) and 10-50% GG4 (HR 2.43; 95% CI: 1.10-5.37; P=0.03) were associated with BCRFS after prostatectomy. In adjusted analysis, invasive cribriform and/or intraductal carcinoma was an independent predictor for BCRFS (HR 2.40; 95% CI: 1.03-5.60; P=0.04) after prostatectomy, whereas percentage %GG4 (HR 1.00; 95% CI: 0.97-1.03; P=0.80) was not. While invasive cribriform and/or intraductal carcinoma (HR 2.58; 95% CI: 1.59-4.21; P<0.001) performed better than 10-50% GG4 (HR 1.24; 95% CI: 0.67-2.29; P=0.49) for prediction of BCRFS after radiation therapy, both parameters were insignificant in analysis adjusted for prostate-specific antigen (P=0.001), positive biopsies (P<0.001) and tumor volume (P=0.05). In conclusion, increased %GG4 is associated with invasive cribriform and/or intraductal carcinoma in GS 3+4=7 prostate cancer biopsies. Invasive cribriform and/or intraductal carcinoma is an independent parameter for BCR after prostatectomy, whereas %GG4 is not. The presence of invasive cribriform and/or intraductal carcinoma has to be included in pathology reports and should act as exclusion criterion for active surveillance.

摘要

Gleason 4级和浸润性或导管内筛状癌都与Gleason 7 分(GS 7)前列腺癌的不良预后相关。本研究的目的是调查Gleason4级肿瘤百分比(%GG4)与浸润性或导管内筛状癌(CR/IDC)在3+4 = 7分前列腺癌活检标本中的关系。我们复习了1031例欧洲前列腺癌筛查随机研究的活检标本。其中共有370例男性存在3+4 = 7分的前列腺癌。用COX回归分析的方法研究在前列腺癌根治术和放疗后,CR/IDC和%GG4与生化无病生存期(BCRFS)的关系。在GG4百分比为110%的病例组中CR/IDC的比例为7/121 (6%);在GG4百分比为1025%的病例组中CR/IDC的比例为29/131 (22%);在GG4百分比为2550%的病例组中CR/IDC的比例为52/118 (44%)。(P0.001)。粗略分析显示,根治术后,CR/IDC(HR 2.72; 95% CI: 1.335.95; P = 0.006)和 1050% GG4 (HR 2.43; 95% CI: 1.105.37; P = 0.03)都与 BCRFS 相关。校正分析显示CR/IDC是根治术后BCRFS独立的预测因素(HR 2.40; 95% CI: 1.035.60; P = 0.04) 。但%GG4 (HR 1.00; 95% CI: 0.971.03; P = 0.80) 不是。对于放疗后BCRFS,虽然CR/IDC(HR 2.58; 95% CI: 1.594.21; P0.001) 比1050% GG4 (HR 1.24; 95% CI: 0.672.29; P = 0.49)的预测效果更好。但在用PSA,阳性穿刺比例和肿瘤体积做过校正分析后,两者都没有统计学意义。总之,GS 3+4 = 7的前列腺癌活检标本中,%GG4的增加与CR/IDC增加有关,CR/IDC是根治术后BCR的独立预后因素,而%GG4不是。CR/IDC应该包括在病理报告中。


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