Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
Hum Pathol. 2021 Dec;118:18-29. doi: 10.1016/j.humpath.2021.09.005. Epub 2021 Sep 17.
Cribriform Gleason pattern 4 (CGP4) is an indicator of poor prognosis in Gleason Score 7 prostate cancer; however, the significance of the size and percentage of this pattern and the presence of concomitant intraductal carcinoma (IDC) in these patients is unclear. To study the significance of these parameters in radical prostatectomy specimens, 165 cases with CGP4 were identified and reviewed (2017-2019). The size and percentage cribriform pattern and presence of IDC were noted and correlated with adverse pathological features and biochemical recurrence (BCR)-free survival. On review, 156 cases had CGP4 (Grade Group 2: 87 and Grade Group 3: 69). Large cribriform pattern and cribriform percentage of >20% showed significant association with extraprostatic extension, surgical margin positivity, and presence of IDC, whereas the presence of IDC was associated with all the analyzed adverse pathological features. BCR was seen in 22 of 111 (20%) patients after a median follow-up of 11 months, and of these, 21 had large cribriform pattern. On univariate analysis, all parameters had significant predictive values for BCR-free survival except for tertiary Gleason pattern 5. On multivariate analysis, while >20% cribriform pattern was trending to be an independent predictor, only lymphovascular invasion was statistically significant. Large cribriform pattern, >20% cribriform, and presence of IDC are additional pathologic parameters of potential value in identifying patients with high risk for early BCR.
筛状 Gleason 模式 4（CGP4）是 Gleason 评分 7 前列腺癌预后不良的指标；然而，这种模式的大小和百分比以及同时存在的导管内癌（IDC）在这些患者中的意义尚不清楚。为了研究这些参数在根治性前列腺切除标本中的意义，我们鉴定并回顾了 165 例有 CGP4 的病例（2017-2019 年）。记录了筛状模式的大小和百分比以及 IDC 的存在，并将其与不良病理特征和生化复发（BCR）无复发生存相关联。回顾性分析显示，156 例有 CGP4（G 分组 2：87 例，G 分组 3：69 例）。大筛状模式和筛状百分比>20%与前列腺外延伸、手术切缘阳性和 IDC 的存在有显著相关性，而 IDC 的存在与所有分析的不良病理特征均有关。在中位随访 11 个月后，111 例患者中有 22 例（20%）发生 BCR，其中 21 例有大筛状模式。在单因素分析中，所有参数对 BCR 无复发生存均有显著预测价值，除三级 Gleason 模式 5 外。多因素分析显示，虽然>20%的筛状模式有成为独立预测因子的趋势，但只有血管淋巴管侵犯具有统计学意义。大筛状模式、>20%筛状和 IDC 的存在是识别早期 BCR 高危患者的潜在有价值的附加病理参数。
