Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
Hum Pathol. 2020 Apr;98:74-80. doi: 10.1016/j.humpath.2020.02.004. Epub 2020 Feb 28.
The prognostic significance of the Gleason grading system has been well established. However, individual Gleason patterns comprise heterogeneous morphologies which might add additional prognostic information. Recent evidence suggests that Gleason pattern 4 with cribriform growth pattern is associated with an adverse prognosis. To determine the association between cribriform pattern on biopsies and pathological findings on subsequent prostatectomies, we evaluated the presence of cribriform architecture in a prospective cohort of 367 men from 2014 to 2018 treated at a single institution. Cribriform architecture was present in 63.5% of all biopsies and was correlated with the overall extent of Gleason pattern 4. In addition, cribriform morphology on biopsy showed a statistically significant association with higher Gleason grade and increased pathological stage and nodal metastasis. In a subset analysis of cases with Grade Group 2 (Gleason score 3 + 4, n = 208), these associations did not reach statistical significance, but the presence of cribriform growth in this subgroup showed a trend toward increased upgrading to Grade Group 5 (Gleason score 9/10) (1 [0.5%] vs. 5 [2.4%], P = 0.06). This large prospective study comparing biopsy and prostatectomy finding of cribriform architecture demonstrates that cribriform pattern 4 is associated with adverse prognostic features and highlights the relevance for recognizing specific morphologies with distinct biological and clinical features.
格里森分级系统的预后意义已经得到了充分证实。然而，个别格里森模式包含异质形态，这可能增加额外的预后信息。最近的证据表明，具有筛状生长模式的格里森模式 4 与不良预后相关。为了确定活检中筛状模式与随后前列腺切除术的病理发现之间的关联，我们评估了 2014 年至 2018 年在一家机构治疗的 367 名男性前瞻性队列中活检中存在筛状结构的情况。所有活检中存在筛状结构的比例为 63.5%，与总体格里森模式 4 程度相关。此外，活检中的筛状形态与较高的格里森分级、增加的病理分期和淋巴结转移具有统计学显著关联。在具有等级组 2（格里森评分 3+4，n=208）的病例亚组分析中，这些关联没有达到统计学意义，但在这个亚组中存在筛状生长显示出向等级组 5（格里森评分 9/10）升级的趋势（1 [0.5%] 比 5 [2.4%]，P=0.06）。这项比较活检和前列腺切除术发现的筛状结构的大型前瞻性研究表明，格里森模式 4 与不良预后特征相关，并强调了识别具有不同生物学和临床特征的特定形态的重要性。
