Flood Trevor A, Schieda Nicola, Sim Jordan, Breau Rodney H, Morash Chris, Belanger Eric C, Robertson Susan J
Department of Pathology and Laboratory Medicine, The Ottawa Hospital, 501 Smyth Road, 4th Floor CCW, Ottawa, ON, K1H 8L6, Canada.
Department of Medical Imaging, The Ottawa Hospital, Ottawa, Canada.
Virchows Arch. 2018 Feb;472(2):205-212. doi: 10.1007/s00428-017-2241-9. Epub 2017 Oct 3.
We assessed Gleason pattern 5 (GP5) and other prostatic adenocarcinoma (PCa) morphologies to determine their association with biochemical recurrence (BCR). A search for grade group 5 PCa with radical prostatectomy (RP) yielded 49 patients. RPs were reviewed for %GP5 and morphologies (sheets, single cells, cords, small solid cylinders, solid medium to large nests with rosette-like spaces [SMLNRS], comedonecrosis, cribriform glands, glomerulations, intraductal carcinoma of the prostate [IDC-P], and prostatic ductal adenocarcinoma [PDCa]). Prevalence of morphologies was as follows: single cells 100%, cribriform glands 98.7%, cords 85.7%, IDC-P 77.6%, comedonecrosis 53.1%, sheets 49.0%, small solid cylinders 49.0%, PDCa 44.9%, glomerulations 34.7%, and SMLNRS 14.3%. From 28 patients who were treated with RP as monotherapy, 64.3% (18/28) had BCR. Comedonecrosis, sheets, small solid cylinders, IDC-P, and PDCa were significantly associated with BCR. Number of morphologies on RP and %GP5 were higher in patients with BCR (6.8 ± 2.1 versus 3.7 ± 2.9%; P < 0.001 and 26.9 ± 16.8 versus 11.4 ± 14.1%; P = 0.02) with area under ROC curve of 0.89 (confidence intervals [CI] 0.77-1.00). Sensitivity/specificity was 77.8/80.0% for predicting BCR when ≥ 5 morphologies were present and 0.79 (CI 0.60-0.99) with sensitivity/specificity of 66.7/80.0% for predicting BCR when ≥ 15% GP5 was present. Hazard ratio for BCR was higher with increasing number of morphologies (1.23, CI 1.02-1.49; P = 0.034) but not %GP5 (0.99, CI 0.97-1.02, P = 0.622). Our results indicate that GP5 morphologies may represent a biologically heterogeneous group and that an increasing number of PCa morphologies on RP is strongly associated with an increased risk of BCR.
我们评估了 Gleason 5 级（GP5）及其他前列腺腺癌（PCa）形态，以确定它们与生化复发（BCR）的关联。对接受根治性前列腺切除术（RP）的 5 级前列腺癌患者进行检索，共纳入 49 例患者。回顾 RP 标本，观察 GP5 的比例及形态（片状、单个细胞、条索状、小实性圆柱体、有玫瑰花结样间隙的实性中到大巢状[SMLNRS]、粉刺样坏死、筛状腺体、肾小球样结构、前列腺导管内癌[IDC-P]以及前列腺导管腺癌[PDCa]）。各形态的发生率如下：单个细胞 100%，筛状腺体 98.7%，条索状 85.7%，IDC-P 77.6%，粉刺样坏死 53.1%，片状 49.0%，小实性圆柱体 49.0%，PDCa 44.9%，肾小球样结构 34.7%，SMLNRS 14.3%。在 28 例接受单纯 RP 治疗的患者中，64.3%（18/28）发生了 BCR。粉刺样坏死、片状、小实性圆柱体、IDC-P 和 PDCa 与 BCR 显著相关。发生 BCR 的患者 RP 上的形态数量及 GP5 比例更高（6.8 ± 2.1 对 3.7 ± 2.9%；P < 0.001 以及 26.9 ± 16.8 对 11.4 ± 14.1%；P = 0.02），ROC 曲线下面积为 0.89（置信区间[CI] 0.77 - 1.00）。当存在≥5 种形态时，预测 BCR 的敏感性/特异性为 77.8/80.0%，当 GP5≥15%时，预测 BCR 的敏感性/特异性为 66.7/80.0%，曲线下面积为 0.79（CI 0.60 - 0.99）。BCR 的风险比随形态数量增加而升高（1.23，CI 1.02 - 1.49；P = 0.034），但与 GP5 比例无关（0.99，CI 0.97 - 1.02，P = 0.622）。我们的结果表明，GP5 形态可能代表一个生物学异质性群体，且 RP 上 PCa 形态数量增加与 BCR 风险增加密切相关。
