Nunez Bragayrac Luciano A, Murekeyisoni Christine, Vacchio Michael J, Attwood Kristopher, Mehedint Diana C, Mohler James L, Azabdaftari Gissou, Xu Bo, Kauffman Eric C
Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY.
Prostate. 2017 Jul;77(10):1076-1081. doi: 10.1002/pros.23364. Epub 2017 May 26.
Retrospective identification of Gleason pattern 4 in metastatic Gleason score 3 + 3 = 6 (GS6) radical prostatectomy (RP) specimens has suggested true GS6 prostate cancer (CaP) lacks metastatic potential. However, pathologist awareness of study design and metastasis outcomes at the time of RP review might have introduced upgrading bias. We used pathologist-blinded methodology for unbiased characterization of metastasis rates for contemporarily defined pathologic GS6 (pGS6) CaP.
An institutional RP database was queried to identify pGS6 patients with metastasis or concern for micrometastasis based on: 1) biochemical failure (BF) despite negative surgical margins or 2) incomplete biochemical response to salvage/adjuvant radiation. RP specimens were regraded independently by two genitourinary pathologists blinded to study aims or clinical outcomes. Additional blinding was performed by random inclusion of pGS6 control specimens from BF-free patients. Only upgrading identified independently by both pathologists was considered.
Among 451 pGS6 patients identified, none had synchronous lymph node metastases and 43/451 (10%) suffered BF. Two patients (0.4%) developed metachronous metastasis during a 110-month median follow-up for BF patients. Both metastatic cases had Gleason pattern 4 on blinded RP review, as did 88% of cases with concern for micrometastasis versus 38% of control cases (P = 0.02). All BF patients (29/29) undergoing postoperative radiation had a complete biochemical response or Gleason pattern 4 on blinded RP review.
Unbiased pathologist review of archival RP specimens supports absent metastatic potential for contemporarily defined GS6 CaP. Reduced postoperative monitoring is appropriate for pGS6, but may require pathology review to confirm absent Gleason pattern 4.
在转移性 Gleason 评分 3+3=6（GS6）的根治性前列腺切除术（RP）标本中对 Gleason 4 级模式进行回顾性鉴定表明，真正的 GS6 前列腺癌（CaP）缺乏转移潜能。然而，在 RP 复查时病理学家对研究设计和转移结果的认知可能导致了分级上调偏差。我们采用病理学家盲法对当代定义的病理 GS6（pGS6）CaP 的转移率进行无偏倚特征描述。
查询机构 RP 数据库，以识别基于以下情况发生转移或存在微转移担忧的 pGS6 患者：1）尽管手术切缘阴性但出现生化复发（BF），或 2）对挽救性/辅助性放疗的生化反应不完全。RP 标本由两名对研究目的或临床结果不知情的泌尿生殖病理学家独立重新分级。通过随机纳入无 BF 患者的 pGS6 对照标本进行额外的盲法操作。仅考虑两名病理学家均独立鉴定出的分级上调情况。
在鉴定出的 451 例 pGS6 患者中，无同步淋巴结转移，43/451（10%）出现 BF。在对 BF 患者进行的中位 110 个月随访期间，2 例患者（0.4%）发生异时转移。在盲法 RP 复查中，两例转移病例均有 Gleason 4 级模式，在存在微转移担忧的病例中有 88%出现该情况，而对照病例中为 38%（P=0.02）。所有接受术后放疗的 BF 患者（29/29）在盲法 RP 复查中均有完全生化反应或 Gleason 4 级模式。
对存档 RP 标本进行无偏倚的病理学家复查支持当代定义的 GS6 CaP 无转移潜能。对于 pGS6 患者，减少术后监测是合适的，但可能需要病理复查以确认无 Gleason 4 级模式。
