Department of Pathology, Laboratory Medicine Program, Anatomic Pathology, University Health Network, Toronto, Ontario, Canada.
Department of Pathology, Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Prostate. 2022 Feb;82(3):345-351. doi: 10.1002/pros.24279. Epub 2021 Dec 8.
To validate the importance of recently established adverse histopathology features (cribriform pattern and intraductal carcinoma) as contra-indication for deferred treatment of Gleason score 7 (3 + 4) (grade group [GG] 2) prostate cancer, we investigated their frequency in GG2 radical prostatectomies with syn- or metachronous metastatic disease.
GG2 prostatectomy specimens of patients with concomitant lymph node metastasis or distant metastasis at follow-up were identified in a clinical database of a tertiary care center and their pathology was reviewed for pathological stage, lymphovascular invasion, Gleason grade 4 subpatterns, presence of tertiary grade 5, and ductal adenocarcinoma histology. A control group of 99 GG2 prostatectomy specimens who had no metastatic disease (controls) was reviewed for the same adverse pathological features.
Of 1860 GG2 prostatectomy specimens (operated between 2002 and 2020), 45 (2.4%) had concurrent regional lymph node metastases or distant metastases at follow-up. Pathological stage distribution of cases and controls was 24% and 79% pT2, 42% and 15% pT3a, 33% and 6.1% pT3b -T4, respectively (p < 0.001). Eleven of 45 cases (24%) had ≤10% Gleason grade 4 component. Cribriform pattern or intraductal carcinoma was present in 84% of cases versus 34% of controls (p < 0.001), tertiary grade 5 in 16% of cases versus 5% controls (p = 0.05) and ductal adenocarcinoma in 16% of cases versus 2% of controls (p = 0.004). Among the seven cases without cribriform or intraductal carcinoma, two displayed ductal adenocarcinoma features.
Well-established unfavorable histopathologic features (intraductal and cribriform pattern carcinoma, ductal adenocarcinoma) are represented in about 90% of GG2 prostate cancers with local or distant metastatic disease and are much less common (38%) in those without metastatic disease. Strikingly, about 25% of GG2 prostatectomy cases with metastatic disease had an organ-confined disease and/or a small percentage of Gleason grade 4 pattern. This further emphasizes the relative importance of these adverse histopathological features (cribriform, intraductal, and ductal adenocarcinoma) rather than percentage Gleason grade 4 as contra-indicator of deferred treatment for patients with GG2 prostate cancer.
为了验证最近确定的不良组织病理学特征（筛状模式和导管内癌）作为 Gleason 评分 7（3+4）（GG2）前列腺癌延迟治疗的禁忌症的重要性，我们研究了它们在伴有同步或异时转移性疾病的 GG2 前列腺根治性切除术标本中的频率。
在一家三级保健中心的临床数据库中确定了伴有淋巴结转移或随访时远处转移的 GG2 前列腺切除术标本，并对其进行病理分期、脉管侵犯、Gleason 4 亚模式、存在三级 5 级和导管腺癌组织学的回顾性研究。对 99 例无转移疾病（对照组）的 GG2 前列腺切除术标本进行了相同的不良病理特征回顾性研究。
在 1860 例 GG2 前列腺切除术标本（2002 年至 2020 年期间手术）中，45 例（2.4%）在随访时出现局部淋巴结转移或远处转移。病例和对照组的病理分期分布分别为 24%和 79%为 pT2，42%和 15%为 pT3a，33%和 6.1%为 pT3b-T4（p<0.001）。45 例中有 11 例（24%）的 Gleason 4 级成分≤10%。病例组中存在筛状或导管内癌的比例为 84%，而对照组为 34%（p<0.001），三级 5 级的比例为 16%，而对照组为 5%（p=0.05），导管腺癌的比例为 16%，而对照组为 2%（p=0.004）。在没有筛状或导管内癌的 7 例中，有 2 例显示出导管腺癌的特征。
在局部或远处转移的 GG2 前列腺癌中，约 90%存在既定的不良组织病理学特征（导管内和筛状癌、导管腺癌），而在无转移疾病的患者中，这些特征（38%）则较少见。引人注目的是，大约 25%的转移性 GG2 前列腺癌病例具有器官局限性疾病和/或少量 Gleason 分级 4 模式。这进一步强调了这些不良组织病理学特征（筛状、导管内和导管腺癌）的相对重要性，而不是 Gleason 分级 4 模式的百分比作为 GG2 前列腺癌患者延迟治疗的禁忌症。
