Teramoto Yuki, Numbere Numbereye, Wang Ying, Miyamoto Hiroshi
From the Department of Pathology & Laboratory Medicine (Teramoto, Numbere, Wang, Miyamoto), University of Rochester Medical Center, Rochester, New York.
James P. Wilmot Cancer Institute (Teramoto, Miyamoto), University of Rochester Medical Center, Rochester, New York.
Arch Pathol Lab Med. 2023 Nov 1;147(11):1261-1267. doi: 10.5858/arpa.2022-0244-OA.
CONTEXT.—: Seminal vesicle invasion (SVI) as pT3b prostate cancer generally, but not uniformly, indicates poor prognosis.
OBJECTIVE.—: To determine the clinical impact of pT3a lesions (ie, extraprostatic extension other than seminal vesicle or bladder invasion [EPE], microscopic bladder neck invasion [mBNI]), as well as unilateral (Uni) versus bilateral (Bil) SVI in pT3b disease.
DESIGN.—: We assessed radical prostatectomy findings and long-term oncologic outcomes in 248 consecutive patients with pT3b disease.
RESULTS.—: Focal EPE, nonfocal EPE, mBNI, Uni-SVI, and Bil-SVI were identified in 13 (5.2%), 206 (83.1%), 48 (19.4%), 109 (44.0%), and 139 (56.0%) cases, respectively. Of possible combinations, we eventually divided our cases into 3 cohorts-Group 1: Uni/Bil-SVI and EPE-/mBNI- (n = 28; 11.3%); Group 2: Uni-SVI and EPE or mBNI (n = 103; 41.5%); and Group 3: Bil-SVI and EPE or mBNI (n = 70; 28.2%) or Uni/Bil-SVI and EPE+/mBNI+ (n = 47; 19.0%). Group 3 patients showed significant adverse histopathologic findings, compared with Group 1 or Group 2 patients. Kaplan-Meier analysis revealed that the prognosis was worse in the following order: Group 1, Group 2, and Group 3; and the differences in progression-free survival between any 2 groups were statistically significant. These significant differences were also seen in subgroups, such as those without or with adjuvant therapy before recurrence and those without lymph node metastasis. Additionally, Group 3 patients had a significantly higher risk of cancer-specific mortality than Group 2 patients. In multivariate analysis (Group 2 as a reference), Group 1 (hazard ratio [HR] = 0.169, P = .01) and Group 3 (HR = 1.620, P = .04) showed significance for progression.
CONCLUSIONS.—: From these significant findings, we propose a novel pT3b subclassification, namely pT3b1 (Group 1), pT3b2 (Group 2), and pT3b3 (Group 3), which more accurately stratifies its prognosis.
精囊侵犯（SVI）作为pT3b期前列腺癌通常（但并非一致）提示预后不良。
确定pT3a期病变（即精囊或膀胱侵犯以外的前列腺外侵犯[EPE]、显微镜下膀胱颈侵犯[mBNI]）以及pT3b期疾病中单侧（Uni）与双侧（Bil）SVI的临床影响。
我们评估了248例连续的pT3b期疾病患者的前列腺癌根治术结果和长期肿瘤学结局。
分别在13例（5.2%）、206例（83.1%）、48例（19.4%）、109例（44.0%）和139例（56.0%）病例中发现局灶性EPE、非局灶性EPE、mBNI、单侧SVI和双侧SVI。在可能的组合中，我们最终将病例分为3组——第1组：单侧/双侧SVI且EPE-/mBNI-（n = 28；11.3%）；第2组：单侧SVI且EPE或mBNI（n = 103；41.5%）；第3组：双侧SVI且EPE或mBNI（n = 70；28.2%）或单侧/双侧SVI且EPE+/mBNI+（n = 47；19.0%）。与第1组或第2组患者相比，第3组患者显示出显著的不良组织病理学发现。Kaplan-Meier分析显示，预后按以下顺序变差：第1组、第2组和第3组；任意两组之间的无进展生存期差异具有统计学意义。在亚组中也观察到这些显著差异，例如复发前未接受或接受辅助治疗的亚组以及无淋巴结转移的亚组。此外，第3组患者的癌症特异性死亡风险显著高于第2组患者。在多变量分析中（以第2组为参照），第1组（风险比[HR] = 0.169，P = 0.01）和第3组（HR = 1.620，P = 0.04）显示出进展方面的显著性。
基于这些显著发现，我们提出一种新的pT3b亚分类，即pT3b1（第1组）、pT3b2（第2组）和pT3b3（第3组），其能更准确地对预后进行分层。
