Siadat Farshid, Sykes Jenna, Zlotta Alexandre R, Aldaoud Najla, Egawa Shin, Pushkar Dmitry, Kuk Cynthia, Bristow Robert G, Montironi Rodolfo, van der Kwast Theodorus
Department of Anatomical Pathology, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
Biostatistics, Princess Margaret Cancer Center, Toronto, Ontario, Canada.
Prostate. 2015 Sep;75(12):1277-84. doi: 10.1002/pros.23009. Epub 2015 May 11.
The Gleason grading system represents the cornerstone of the management of prostate cancer. Gleason grade 4 (G4) is a heterogeneous set of architectural patterns, each of which may reflect a distinct prognostic value.
We determined the prevalence of the various G4 architectural patterns and intraductal carcinoma (IDC) in latent prostate cancer in contemporary Russian (n = 220) and Japanese (n = 100) autopsy prostates and in cystoprostatectomy (CP) specimens (n = 248) collected in Italy. We studied the association of each G4 pattern with extraprostatic extension (EPE) and tumor volume to gain insight into their natural history. Presence of IDC and nine architectural features of Gleason grade 4 and 5 cancer were recorded.
The prevalence of Gleason score ≥ 7 PC was higher in the autopsy series (11%) compared to the CP series (6.5%, P = 0.04). The prevalence of IDC and carcinoma with a cribriform architecture was 2.2% and 3.4% in the autopsy series and 0.8% and 3.6% in the cystoprostatectomy series, respectively. In multivariable analysis, cribriform architecture was significantly associated with increased tumor volume (P < 0.001) and EPE (OR:11.48, 95%CI:2.30-57.16, P = 0.003). IDC was also significantly associated with EPE (OR:10.08, 95%CI:1.58-64.28, P = 0.014). Small fused glands had a strong negative association with EPE in the autopsy series (OR:0.06, 95%CI:0.01-0.58, P = 0.015).
Our study revealed that in latent prostate cancer both cribriform architecture and IDC are uniquely associated with poor pathological outcome features. In contrast, Gleason score 7 (3 + 4) cancers with small-fused gland pattern might possibly include some prostate cancers with a more indolent biology.
Gleason分级系统是前列腺癌管理的基石。Gleason 4级（G4）是一组异质性的结构模式，每种模式可能反映不同的预后价值。
我们确定了当代俄罗斯（n = 220）和日本（n = 100）尸检前列腺以及意大利收集的膀胱前列腺切除术（CP）标本（n = 248）中潜伏性前列腺癌的各种G4结构模式和导管内癌（IDC）的患病率。我们研究了每种G4模式与前列腺外扩展（EPE）和肿瘤体积的关联，以深入了解它们的自然病史。记录IDC的存在以及Gleason 4级和5级癌的九种结构特征。
尸检系列中Gleason评分≥7的前列腺癌患病率（11%）高于CP系列（6.5%，P = 0.04）。尸检系列中IDC和筛状结构癌的患病率分别为2.2%和3.4%，膀胱前列腺切除术系列中分别为0.8%和3.6%。在多变量分析中，筛状结构与肿瘤体积增加（P < 0.001）和EPE显著相关（OR：11.48，95%CI：2.30 - 57.16，P = 0.003）。IDC也与EPE显著相关（OR：10.08，95%CI：1.58 - 64.28，P = 0.014）。在尸检系列中，小融合腺与EPE有很强的负相关（OR：0.06，95%CI：0.01 - 0.58，P = 0.015）。
我们的研究表明，在潜伏性前列腺癌中，筛状结构和IDC均与不良病理结果特征独特相关。相比之下，具有小融合腺模式的Gleason评分7（3 + 4）癌可能包括一些生物学行为较惰性的前列腺癌。
