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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

发布日期:2017/11/6 22:38:44 文章来源: 作者: 点击次数:7383

 

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Mod Pathol. 2017 Aug;30(8):1126-1132.

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

 

Kweldam CF1, Kümmerlin IP1, Nieboer D2, Steyerberg EW2, Bangma CH3, Incrocci L4, van der Kwast TH5, Roobol MJ3, van Leenders GJ1.

1Department of Pathology, Erasmus Medical Centre, Josephine Nefkens Institute, Rotterdam, The Netherlands. 2Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands. 3Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands. 4Department of Radiotherapy, Erasmus Medical Centre, Rotterdam, The Netherlands. 5Laboratory Medicine Program, University Health Network, Toronto, ON, Canada.

 

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 110% GG4, 29/131 (22%) with 1025%, and 52/118 (44%) with 2550% GG4 (P0.001). In crude analysis, both invasive cribriform and/or intraductal carcinoma (HR 2.72; 95% CI: 1.335.95; P = 0.006) and 1050% GG4 (HR 2.43; 95% CI: 1.105.37; 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: 1.035.60; P = 0.04) after prostatectomy, whereas percentage %GG4 (HR 1.00; 95% CI: 0.971.03; P = 0.80) was not. While invasive cribriform and/or intraductal carcinoma (HR 2.58; 95% CI: 1.594.21; P0.001) performed better than 1050% GG4 (HR 1.24; 95% CI: 0.672.29; 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 (P0.001) 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.

 

 

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

 

摘要:Gleason 4级和浸润性或导管内筛状癌都与Gleason 7 (GS 7)的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 %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) 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) 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。(翻译 卫美辰)

 

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