Department of Pathology, Erasmus Medical Centre, Josephine Nefkens Institute, Rotterdam, The Netherlands.
Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands.
Mod Pathol. 2017 Aug;30(8):1126-1132. doi: 10.1038/modpathol.2017.29. Epub 2017 May 19.
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.
在 GS 7 前列腺癌中，肿瘤分级 4 级的相对增加和存在侵袭性筛状和/或导管内癌已分别与不良的 Gleason 评分 7（GS 7）前列腺癌预后相关。本研究的目的是研究 GS 3+4=7 前列腺癌活检中 Gleason 分级 4 级肿瘤百分比（%GG4）和侵袭性筛状和/或导管内癌之间的关系。我们回顾了欧洲前列腺癌筛查随机研究中的 1031 例前列腺癌活检。共有 370 名男性患有 G3+4=7。使用 Cox 回归分析根治性前列腺切除术（n=146）和放射治疗（n=195）后侵袭性筛状和/或导管内癌和%GG4 与生化无复发生存（BCRFS）之间的关系。在 121 名（6%）1-10% GG4 患者中，29 名（22%）10-25% GG4 和 52 名（44%）25-50% GG4 患者中发生侵袭性筛状和/或导管内癌（P<0.001）。在粗分析中，侵袭性筛状和/或导管内癌（HR 2.72；95%CI：1.33-5.95；P=0.006）和 10-50% GG4（HR 2.43；95%CI：1.10-5.37；P=0.03）与前列腺切除术后的 BCRFS 相关。在调整分析中，侵袭性筛状和/或导管内癌是前列腺切除术后 BCRFS 的独立预测因子（HR 2.40；95%CI：1.03-5.60；P=0.04），而%GG4（HR 1.00；95%CI：0.97-1.03；P=0.80）不是。侵袭性筛状和/或导管内癌（HR 2.58；95%CI：1.59-4.21；P<0.001）在预测放射治疗后的 BCRFS 方面优于 10-50% GG4（HR 1.24；95%CI：0.67-2.29；P=0.49），但在调整前列腺特异性抗原（P=0.001）、阳性活检（P<0.001）和肿瘤体积（P=0.05）的分析中，这两个参数均不显著。总之，GS 3+4=7 前列腺癌活检中，%GG4 与侵袭性筛状和/或导管内癌相关。侵袭性筛状和/或导管内癌是前列腺切除术后 BCR 的独立参数，而%GG4 不是。侵袭性筛状和/或导管内癌的存在必须在病理报告中报告，并应作为主动监测的排除标准。
