Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
Anatomic Pathology, Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Mod Pathol. 2022 Nov;35(11):1695-1701. doi: 10.1038/s41379-022-01111-w. Epub 2022 Jun 8.
Pretreatment classification tools are used in prostate cancer to inform patient management. The effect of cribriform pattern 4 (CC) and intraductal carcinoma (IDC) on such nomograms is still underexplored. We analyzed the Cancer of Prostate Risk Assessment (CAPRA) and National Comprehensive Cancer Network (NCCN) risk scores in cases with and without CC/IDC to assess impact on biochemical recurrence (BCR) and metastases/death of prostate cancer (event free survival-EFS) after prostatectomy. A matched biopsy- prostatectomy cohort (2010-2017) was reviewed for CC/IDC. CAPRA and NCCN scores were calculated. CAPRA score 0-2 were deemed "low", 3-5 "intermediate" and 6-10 "high". NCCN scores 1-2 "very low/low", 3 "favorable intermediate", 4 "unfavorable intermediate", 5-6 "high/very high". Cases were stratified by presence of CC/IDC. BCR and EFS probabilities were estimated using the Kaplan-Meier method. Prognostic performance was evaluated using log-rank tests and Harrell's concordance index. 612 patients with mean age 63.1 years were included with mean follow up of 5.3 (range 0-10.8) years. CC/IDC was noted in 159/612 (26%) biopsies. There were 101 (17%) BCR and 36 (6%) events. CAPRA discriminated three distinct risk categories for BCR (p < 0.001) while only high risk separated significantly for EFS (p < 0.001). NCCN distinguished two prognostic groups for BCR (p < 0.0001) and three for EFS (p < 0.0001). Addition of CC/IDC to CAPRA impacted scores 3-5 for BCR and scores 3-5 and 6-10 for EFS and improved the overall concordance index (BCR: 0.66 vs. 0.71; EFS: 0.74 vs. 0.80). Addition of CC/IDC to NCCN impacted scores 4 and 5-6 and also improved the concordance index for BCR (0.62 vs. 0.68). Regarding EFS, NCCN scores 4 and 5-6 demonstrated markedly different outcomes with the addition of CC/IDC. The CAPRA nomogram allows better outcome stratification than NCCN. Addition of CC/IDC status particularly improves patient stratification for CAPRA scores 3-5, 6-10, and for NCCN scores 4 and 5-6.
预处理分类工具用于前列腺癌，以告知患者管理。4 型筛状模式 (CC) 和管内癌 (IDC) 对这些列线图的影响仍未得到充分探索。我们分析了前列腺癌风险评估 (CAPRA) 和国家综合癌症网络 (NCCN) 风险评分在有和没有 CC/IDC 的病例中，以评估其对前列腺切除术后生化复发 (BCR) 和转移/死亡的影响。对 2010-2017 年的活检-前列腺切除术队列进行了回顾，以确定 CC/IDC。计算 CAPRA 和 NCCN 评分。CAPRA 评分 0-2 为“低”，3-5 为“中”，6-10 为“高”。NCCN 评分 1-2 为“极低/低”，3 为“有利中”，4 为“不利中”，5-6 为“高/极高”。根据存在 CC/IDC 对病例进行分层。使用 Kaplan-Meier 方法估计 BCR 和 EFS 概率。使用对数秩检验和 Harrell 一致性指数评估预后性能。612 名平均年龄为 63.1 岁的患者纳入研究，平均随访时间为 5.3 年（范围 0-10.8 年）。612 例活检中有 159 例（26%）发现 CC/IDC。有 101 例（17%）BCR 和 36 例（6%）事件。CAPRA 区分了 BCR 的三个不同风险类别（p<0.001），而仅高风险对 EFS 有显著差异（p<0.001）。NCCN 区分了 BCR 的两个预后组（p<0.0001）和 EFS 的三个预后组（p<0.0001）。CC/IDC 加入 CAPRA 后，BCR 的评分 3-5 和 EFS 的评分 3-5 和 6-10 受到影响，整体一致性指数得到改善（BCR：0.66 与 0.71；EFS：0.74 与 0.80）。CC/IDC 加入 NCCN 后，BCR 的评分 4 和 5-6 以及一致性指数也得到改善（0.62 与 0.68）。关于 EFS，NCCN 评分 4 和 5-6 随着 CC/IDC 的加入显示出明显不同的结果。CAPRA 列线图比 NCCN 更能进行更好的预后分层。CC/IDC 状态的加入，特别是可以提高 CAPRA 评分 3-5、6-10 和 NCCN 评分 4 和 5-6 的患者分层。
