Numbere Numbereye, Teramoto Yuki, Gurung Pratik M S, Goto Takuro, Yang Zhiming, Miyamoto Hiroshi
From the Department of Pathology & Laboratory Medicine (Numbere, Teramoto, Goto, Yang, Miyamoto), University of Rochester Medical Center, Rochester, New York.
James P. Wilmot Cancer Institute (Teramoto, Goto, Miyamoto), University of Rochester Medical Center, Rochester, New York.
Arch Pathol Lab Med. 2022 May 1;146(5):619-625. doi: 10.5858/arpa.2021-0069-OA.
CONTEXT.—: Seminal vesicle invasion (SVI) by prostate cancer (pT3b disease) has been considered as a key prognostic factor.
OBJECTIVE.—: To assess the clinical impact of T3a lesions (ie, extraprostatic extension other than bladder neck invasion [BNI] or SVI [EPE], microscopic bladder neck invasion [mBNI]) in pT3b disease.
DESIGN.—: We compared radical prostatectomy findings and long-term oncologic outcomes in 248 patients with pT3b disease, with versus without EPE/mBNI.
RESULTS.—: Extraprostatic extension/mBNI was found in 219 (88.3%)/48 (19.4%) cases, respectively. Extraprostatic extension was significantly associated with higher preoperative prostate-specific antigen (PSA) level, higher rates of positive surgical margin (pSM) and lymphovascular invasion (LVI), and larger tumor volume. Similarly, mBNI was significantly associated with higher PSA level, higher rates of Grade Group(s) 4-5 or 5, pSM, LVI, and pN1, and larger tumor volume. Significant differences in all of these clinicopathologic features (except lymph node metastasis) between EPE-/mBNI+ or EPE+/mBNI- and EPE+/mBNI+ cases were also observed. Outcome analysis revealed that patients with EPE (P < .001) or mBNI (P < .001) had a significantly higher risk of disease progression than respective controls. Notably, there were significant differences in progression-free survival between EPE-/mBNI+ or EPE+/mBNI- cases and EPE-/mBNI- (P = .001) or EPE+/mBNI+ (P < .001) cases. In multivariate analysis, EPE (hazard ratio [HR] = 6.53, P = .009) and mBNI (HR = 2.33, P = .003), as well as EPE-/mBNI+ or EPE+/mBNI- (HR = 11.7, P = .01) and EPE+/mBNI+ (HR = 25.9, P = .002) versus EPE-/mBNI-, showed significance for progression.
CONCLUSIONS.—: From these significant findings, we propose a novel pT3b subclassification: pT3b1 (SVI alone without EPE or mBNI), pT3b2 (SVI with either EPE or mBNI), and pT3b3 (SVI with both EPE and mBNI).
前列腺癌（pT3b期疾病）侵犯精囊（SVI）一直被视为关键的预后因素。
评估T3a期病变（即除膀胱颈侵犯[BNI]或SVI外的前列腺外侵犯[EPE]、显微镜下膀胱颈侵犯[mBNI]）在pT3b期疾病中的临床影响。
我们比较了248例pT3b期疾病患者（有或无EPE/mBNI）的根治性前列腺切除术结果和长期肿瘤学结局。
分别在219例（88.3%）/48例（19.4%）病例中发现前列腺外侵犯/mBNI。前列腺外侵犯与术前前列腺特异性抗原（PSA）水平较高、手术切缘阳性（pSM）率和淋巴管侵犯（LVI）率较高以及肿瘤体积较大显著相关。同样，mBNI与PSA水平较高、4-5级或5级分级组、pSM、LVI和pN1率较高以及肿瘤体积较大显著相关。在EPE-/mBNI+或EPE+/mBNI-与EPE+/mBNI+病例之间，所有这些临床病理特征（除淋巴结转移外）也观察到显著差异。结局分析显示，有EPE（P <.001）或mBNI（P <.001）的患者疾病进展风险明显高于各自的对照组。值得注意的是，EPE-/mBNI+或EPE+/mBNI-病例与EPE-/mBNI-（P =.001）或EPE+/mBNI+（P <.001）病例之间的无进展生存期存在显著差异。在多变量分析中，EPE（风险比[HR]=6.53，P =.009）和mBNI（HR =2.33，P =.003），以及EPE-/mBNI+或EPE+/mBNI-（HR =11.7，P =.01）和EPE+/mBNI+（HR =25.9，P =.002）与EPE-/mBNI-相比，在疾病进展方面具有显著性。
基于这些重要发现，我们提出一种新的pT3b亚分类：pT3b1（仅SVI，无EPE或mBNI）、pT3b2（SVI合并EPE或mBNI）和pT3b3（SVI合并EPE和mBNI）。
