University of Texas, M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
Eur Urol. 2010 Jun;57(6):1030-8. doi: 10.1016/j.eururo.2009.10.020. Epub 2009 Oct 17.
Preoperative treatment of prostate cancer (PCa) changes morphology of residual tumors so that the Gleason score is no longer valid.
To codify morphologic features of preoperatively treated PCa and identify potential classifiers predictive of outcome.
DESIGN, SETTING, AND PARTICIPANTS: We performed a detailed morphologic evaluation of specimens obtained from 115 patients with high-risk PCa who had preoperative androgen ablation, alone or in combination with chemotherapy.
Included hierarchical clustering analysis of morphologic characteristics, associations with other pathologic parameters, and univariate and multivariate analyses in search for associations with disease outcome.
Based on hierarchical clustering analysis, we categorized pretreated prostate cancer in three morphologically distinct groups: group A, characterized by a predominance of cell clusters, cell cords, and isolated cells; group B tumors, by intact and fused small glands; and group C tumors by any degree of cribriform growth pattern or intraductal tumor spread. Univariate analysis identified associations between this grouping, pathologic tumor stage (p<0.01) and residual tumor volume (p<0.001). Presence of intraductal spread or cribriform pattern in biopsies was associated with group C tumors. The presence of cribriform or intraductal spread morphology and positive surgical margins were stronger predictors of biochemical relapse than pathologic stage on multivariate analysis. The number of specimens evaluated in this study was limited, and a prospective validation is warranted along with molecular studies to validate the proposed morphologic classifier.
If validated, this classification will introduce uniformity in the selection of tissue samples for biomarker studies, facilitate the comparison of trials among different institutions, and may provide a new prognostic tool for preoperatively treated PCa.
前列腺癌（PCa）的术前治疗改变了残留肿瘤的形态，使得 Gleason 评分不再有效。
对接受过术前治疗的 PCa 标本进行形态学特征分析，并确定潜在的预测预后的分类器。
设计、地点和参与者：我们对 115 例接受过术前雄激素剥夺治疗（单独或联合化疗）的高危 PCa 患者的标本进行了详细的形态学评估。
包括形态特征的层次聚类分析、与其他病理参数的关联，以及单变量和多变量分析，以寻找与疾病结果相关的关联。
基于层次聚类分析，我们将预处理后的前列腺癌分为三种形态学上明显不同的组：A 组以细胞簇、细胞索和孤立细胞为主；B 组肿瘤以完整和融合的小腺体为特征；C 组肿瘤则具有任何程度的筛状生长模式或管内肿瘤扩散。单变量分析确定了这种分组与病理肿瘤分期（p<0.01）和残留肿瘤体积（p<0.001）之间的关联。活检中存在管内扩散或筛状模式与 C 组肿瘤有关。在多变量分析中，存在筛状或管内扩散形态和阳性手术切缘比病理分期是生化复发更强的预测因素。本研究评估的标本数量有限，需要前瞻性验证，并结合分子研究验证所提出的形态学分类器。
如果得到验证，这种分类方法将在选择生物标志物研究的组织样本方面引入一致性，促进不同机构之间的试验比较，并可能为术前治疗的 PCa 提供新的预后工具。
