Oufattole Jihane, Dey Tanujit, D'Amico Anthony V, van Leenders Geert J L H, Acosta Andres M
Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Histopathology. 2023 Jun;82(7):1089-1097. doi: 10.1111/his.14901. Epub 2023 Mar 20.
Grade Group 5 (GG5) prostate cancer (PCa) is associated with a high risk of disease recurrence after radical prostatectomy (~75% at 5 years). However, this is a heterogeneous category that includes neoplasms with different combinations of Gleason pattern (GP) 4 and 5. Within GP4, large cribriform growth has been associated with adverse disease-specific outcomes in GG2-4 PCa. Less is known about the significance of cribriform morphology and the different histologic patterns of GP5 in GG5 PCa.
In this study we evaluated the prognostic implications of cribriform morphology (either invasive or intraductal, henceforth "cribriform") and large solid growth or comedonecrosis (comedo/solid) in patients with GG5 PCa. One-hundred and thirty prostatectomies from a single institution were analysed. The presence of comedo/solid components was associated with a higher frequency of concurrent cribriform PCa (85.7% versus 45.9%, P < 0.001), lymphovascular invasion (44.6% versus 27%, P = 0.04), and biochemical recurrence (48.2% versus 28.4%, P = 0.03). The presence of large cribriform growth was associated with a higher frequency of extraprostatic involvement (i.e. pT3a-b; 85.3% versus 68.7%, P = 0.02), positive surgical margins (47.6% versus 29.2%, P = 0.04) and biochemical recurrence (47.6% versus. 18.7%, P = 0.001). Kaplan-Meier analysis demonstrated that GG5 PCa with cribriform or comedo/solid components had a higher probability of biochemical recurrence. Multivariable analysis showed that only cribriform components were an independent predictor of a higher risk of biochemical recurrence in this series.
These findings highlight the importance of reporting the presence of cribriform components in GG5 PCa and suggest that cribriform morphology might help decide postsurgical management in these patients.
5级组（GG5）前列腺癌（PCa）与根治性前列腺切除术后疾病复发的高风险相关（5年时约为75%）。然而，这是一个异质性类别，包括具有不同Gleason模式（GP）4和5组合的肿瘤。在GP4内，大筛状生长与GG2 - 4 PCa中不良的疾病特异性结局相关。关于GG5 PCa中筛状形态和GP5不同组织学模式的意义知之甚少。
在本研究中，我们评估了GG5 PCa患者中筛状形态（浸润性或导管内，以下简称“筛状”）以及大实性生长或粉刺样坏死（粉刺样/实性）的预后意义。分析了来自单一机构的130例前列腺切除术病例。粉刺样/实性成分的存在与同时存在筛状PCa的频率较高相关（85.7%对45.9%，P < 0.001）、淋巴管侵犯（44.6%对27%，P = 0.04）以及生化复发（48.2%对28.4%，P = 0.03）。大筛状生长的存在与前列腺外累及的频率较高相关（即pT3a - b；85.3%对68.7%，P = 0.02）、手术切缘阳性（47.6%对29.2%，P = 0.（此处原文有误，应为0.04））以及生化复发（47.6%对18.7%，P = 0.001）。Kaplan - Meier分析表明，具有筛状或粉刺样/实性成分的GG5 PCa有更高的生化复发概率。多变量分析显示，在本系列中只有筛状成分是生化复发高风险的独立预测因素。
这些发现突出了报告GG5 PCa中筛状成分存在的重要性，并表明筛状形态可能有助于决定这些患者的术后管理。
