Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
J Urol. 2019 Oct;202(4):710-716. doi: 10.1097/JU.0000000000000316. Epub 2019 Sep 6.
We assessed the impact of cribriform pattern and/or intraductal carcinoma on Gleason 7 prostate cancer treated with external beam radiotherapy.
We evaluated men with Gleason 7 (Grade Groups 2 and 3) prostate cancer treated with dose escalated external beam radiotherapy with or without androgen deprivation. We reviewed biopsies for the presence of cribriform pattern and/or intraductal carcinoma. Study end points included biochemical recurrence-free, distant metastasis-free and disease specific survival.
In the 237 patients median followup was 117 months (range 3 to 236). According to National Comprehensive Cancer Network® risk groups 24% of patients were at favorable intermediate risk, 53% were at unfavorable intermediate risk and 23% were at high risk. The rate of cribriform pattern without intraductal carcinoma, cribriform pattern with intraductal carcinoma, intraductal carcinoma without cribriform pattern and none of these morphologies was 36%, 13%, 0% and 51%, respectively. On multivariable analysis cribriform pattern with intraductal carcinoma (HR 4.22, 95% CI 2.08-8.53, p <0.0001), prostate specific antigen 10 to 20 ng/ml (HR 1.97, 95% CI 1.03-3.79, p=0.04) and prostate specific antigen greater than 20 ng/ml (HR 2.26, 95% CI 1.21-4.23, p=0.01) were associated with worse biochemical recurrence-free survival. On multivariable analysis only cribriform pattern with intraductal carcinoma was associated with inferior distant metastasis-free survival (HR 4.18, 95% CI 1.43-12.28, p=0.01) and disease specific survival (HR 14.26, 95% CI 2.75-74.04, p=0.0016). Factors associated with cribriform pattern with or without intraductal carcinoma included Grade Group 3, high risk group and 50% or more positive biopsy cores. When stratified by neither morphology present, cribriform pattern without intraductal carcinoma and cribriform pattern with intraductal carcinoma the differences in biochemical recurrence-free, distant metastasis-free and disease specific survival were statistically significant (p=0.00042, p=0.017 and p <0.0001, respectively).
Cribriform pattern with intraductal carcinoma was associated with adverse outcomes in men with Gleason 7 prostate cancer treated with external beam radiotherapy while cribriform pattern without intraductal carcinoma was not so associated. Future studies may benefit from dichotomizing these 2 histological entities.
我们评估了在接受外照射放疗的 Gleason 7 前列腺癌患者中，筛状模式和/或导管内癌对预后的影响。
我们评估了接受剂量递增外照射放疗联合或不联合雄激素剥夺治疗的 Gleason 7（分级组 2 和 3）前列腺癌患者。我们回顾了活检标本中筛状模式和/或导管内癌的存在情况。研究终点包括生化无复发生存、远处转移无复发生存和疾病特异性生存。
在 237 例患者中，中位随访时间为 117 个月（范围 3 至 236）。根据国家综合癌症网络®风险分组，24%的患者为中危低危，53%为中危高危，23%为高危。筛状模式伴导管内癌、筛状模式不伴导管内癌、导管内癌不伴筛状模式和无上述形态的比例分别为 36%、13%、0%和 51%。多变量分析显示，筛状模式伴导管内癌（HR 4.22，95%CI 2.08-8.53，p<0.0001）、前列腺特异性抗原 10-20ng/ml（HR 1.97，95%CI 1.03-3.79，p=0.04）和前列腺特异性抗原>20ng/ml（HR 2.26，95%CI 1.21-4.23，p=0.01）与生化无复发生存不良相关。多变量分析仅显示筛状模式伴导管内癌与远处转移无复发生存（HR 4.18，95%CI 1.43-12.28，p=0.01）和疾病特异性生存（HR 14.26，95%CI 2.75-74.04，p=0.0016）相关。与筛状模式伴或不伴导管内癌相关的因素包括分级组 3、高危组和 50%或更多阳性活检核心。当按既没有形态存在、筛状模式不伴导管内癌和筛状模式伴导管内癌进行分层时，在生化无复发生存、远处转移无复发生存和疾病特异性生存方面的差异具有统计学意义（p=0.00042，p=0.017 和 p<0.0001，分别）。
在接受外照射放疗的 Gleason 7 前列腺癌患者中，筛状模式伴导管内癌与不良预后相关，而筛状模式不伴导管内癌则无相关性。未来的研究可能受益于将这两种组织学实体进行二分。
