Department of Anatomic Pathology, University of California, San Francisco, California.
Department of Pathology, Veterans Affairs Health Care System, San Francisco, California.
Prostate. 2020 May;80(8):653-659. doi: 10.1002/pros.23977. Epub 2020 Mar 27.
Molecular testing of prostate cancer biopsies with Gleason pattern 4 suggests the expansile cribriform pattern is more aggressive than the glomerulation pattern. These two extreme patterns have not been compared at prostatectomy. We hypothesized that at prostatectomy the expansile cribriform pattern would be associated with histopathologic and molecular features of aggressiveness and with greater risk of biochemical recurrence (BCR) than the glomerulation pattern.
In a retrospective cohort study, radical prostatectomy reports with expansile cribriform pattern or glomerulation pattern were analyzed for percentage of total pattern 4, extraprostatic extension (EPE), positive lymph nodes, seminal vesicle invasion (SVI), and intraductal carcinoma (IDC). Cases with pattern 5 or with both expansile cribriform and glomerulations patterns present were excluded. The electronic medical record was reviewed for BCR-free survival and for Decipher test results.
Of 1020 radical prostatectomies from July 2015 to July 2018, 110 (11%) had either expansile cribriform or glomerulation pattern present. The expansile cribriform group was associated with more histopathologic features of aggressiveness, with higher average total percentage pattern 4 (43.7 vs 27.0, P = .002), a trend of greater extensive EPE (32.7% vs 17.2%, P = .06), a trend toward statistical significance of higher rate of SVI (11.5% vs 3.4%, P = .1), greater positive lymph nodes (9.6% vs 0%, P = .02), and a higher percentage of cases with or suspicious for IDC (23.1% vs 8.6%, P = .04). The risk of BCR was 4.4 (1.3-15.4) fold greater for the expansile cribriform group vs the glomerulations group (P = .02). For the 38 patients who underwent Decipher testing, the expansile cribriform group had a high-risk assay category mean score whereas the glomerulations group had an average risk assay category mean score (0.61 vs 0.47, P = .02).
In a comparison of prostatectomy cases with expansile cribriform pattern to those with glomerulation pattern, the expansile cribriform pattern was associated with more histopathologic features of aggressiveness, greater risk of biochemical failure, and higher scores with a molecular classifier (Decipher) test. These findings underscore the importance of reporting the types of pattern 4 and supports the argument that men with expansile cribriform likely require more aggressive management.
前列腺癌活检中出现 Gleason 模式 4 的分子检测表明，扩张性筛状模式比肾小球模式更具侵袭性。这两种极端模式在前列腺切除术时尚未进行比较。我们假设在前列腺切除术时，扩张性筛状模式与侵袭性的组织病理学和分子特征以及生化复发（BCR）的风险增加相关，而不是肾小球模式。
在一项回顾性队列研究中，分析了具有扩张性筛状模式或肾小球模式的根治性前列腺切除术报告，以确定总模式 4 的百分比、前列腺外延伸（EPE）、阳性淋巴结、精囊侵犯（SVI）和管内癌（IDC）。排除出现模式 5 或同时存在扩张性筛状和肾小球模式的病例。对电子病历进行了 BCR 无复发生存率和 Decipher 检测结果的回顾性分析。
在 2015 年 7 月至 2018 年 7 月期间进行的 1020 例根治性前列腺切除术病例中，有 110 例（11%）出现扩张性筛状或肾小球模式。扩张性筛状组与侵袭性组织病理学特征更相关，总模式 4 的平均百分比更高（43.7%比 27.0%，P=0.002），EPE 广泛程度呈增加趋势（32.7%比 17.2%，P=0.06），SVI 的发生率也有统计学意义（11.5%比 3.4%，P=0.1），阳性淋巴结更多（9.6%比 0%，P=0.02），且存在或疑似 IDC 的病例百分比更高（23.1%比 8.6%，P=0.04）。与肾小球组相比，扩张性筛状组的 BCR 风险高 4.4 倍（1.3-15.4）（P=0.02）。对 38 例接受 Decipher 检测的患者进行分析，发现扩张性筛状组的高风险检测类别平均评分较高，而肾小球组的平均风险检测类别平均评分较低（0.61 比 0.47，P=0.02）。
在对具有扩张性筛状模式的前列腺切除术病例与具有肾小球模式的病例进行比较时，扩张性筛状模式与更具侵袭性的组织病理学特征、更高的生化失败风险以及更高的分子分类器（Decipher）检测评分相关。这些发现强调了报告模式 4 类型的重要性，并支持了具有扩张性筛状模式的男性可能需要更积极的管理的观点。
