Department of Pathology, University of Colorado, Denver School of Medicine, Aurora, CO 80045, USA.
Am J Clin Pathol. 2011 Jul;136(1):98-107. doi: 10.1309/AJCPZ7WBU9YXSJPE.
Proper grading of the cribriform prostate cancer pattern has not previously been supported by outcome-based evidence. Among 153 men who underwent radical prostatectomy, 76 with prostate-specific antigen (PSA) failure (≥0.2 ng/mL [0.2 μg/L]) were matched to 77 without failure. Frequencies of high-grade patterns included fused small acini, 83.7%; papillary, 52.3%; large cribriform, 37.9%; small (≤12 lumens) cribriform, 17.0%; and individual cells, 22.9%. A cribriform pattern was present in 61% (46/76) of failures but 16% (12/77) of nonfailures (P < .0001). Multivariate analysis showed the cribriform pattern had the highest odds ratio for PSA failure, 5.89 (95% confidence interval, 2.53-13.70; P < .0001). The presence of both large and small cribriform patterns was significantly linked to failure. The cumulative odds ratio of failure per added square millimeter of cribriform pattern was 1.173 (P = .008), higher than for any other pattern. All 8 men with a cribriform area sum of 25 mm(2) or more had failure (range, 33-930). Regrading cribriform cancer as Gleason 5 improved the grade association with failure, although half of all cases with individual cells also had a cribriform pattern, precluding a precise determination of the independent importance of the latter. The cribriform pattern has particularly adverse implications for outcome.
前列腺筛状癌模式的正确分级以前没有得到基于结果的证据的支持。在 153 名接受根治性前列腺切除术的男性中，有 76 名前列腺特异性抗原（PSA）失败（≥0.2ng/mL[0.2μg/L]）与 77 名无失败患者相匹配。高级别模式的频率包括融合小腺泡，83.7%；乳头状，52.3%；大筛状，37.9%；小（≤12 个管腔）筛状，17.0%；和单个细胞，22.9%。在 61%（46/76）的失败病例中存在筛状模式，但在 16%（12/77）的非失败病例中存在（P<.0001）。多变量分析显示，筛状模式与 PSA 失败的比值比最高，为 5.89（95%置信区间，2.53-13.70；P<.0001）。大筛状和小筛状模式的存在与失败显著相关。每增加 1 平方毫米筛状模式的失败累积比值比为 1.173（P=.008），高于任何其他模式。所有 8 名筛状面积总和为 25mm2或以上的患者均有失败（范围为 33-930）。将筛状癌重新分级为 Gleason 5 可提高与失败的分级相关性，尽管一半的具有单个细胞的病例也有筛状模式，这使得后者的独立重要性无法准确确定。筛状模式对结果有特别不利的影响。
