Downes Michelle R, Liu Kristen N, Yu Yanhong, Lajkosz Katherine, Kroon Lisa J, Hollemans Eva, Fleshner Neil, Finelli Antonio, van Leenders Geert J L H, Iczkowski Kenneth A, van der Kwast Theodorus H
Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, Precision Diagnostic & Therapeutic Program, Toronto, Ontario, Canada.
Department of Pathology, Medical College of Wisconsin, Milwaukee, WI.
Clin Genitourin Cancer. 2024 Feb;22(1):47-55. doi: 10.1016/j.clgc.2023.07.013. Epub 2023 Aug 1.
Pretreatment stratification tools can help in clinical decision making in prostate cancer. To date, none incorporates well-established routinely reported adverse prognostic pathologic features such as intraductal carcinoma of prostate (IDC) or cribriform pattern 4 (CC).
To assess the impact of addition of CC and/or IDC on the Cancer of Prostate Risk Assessment (CAPRA) and National Cancer Comprehensive Network (NCCN) tools for predicting biochemical recurrence free survival (BCR-FS) and event-free survival (EFS) across multiple patient cohorts.
DESIGN, SETTING, AND PARTICIPANTS: Matched prostate biopsies and radical prostatectomies from institutions in Toronto, Wisconsin and Rotterdam. The presence/absence of CC/IDC was recorded on all biopsies.
Relationship to outcome was assessed using Cox proportional hazard models, ANOVA and Harrell's concordance index.
We included 1326 patients (Toronto- 612, Wisconsin- 542, Rotterdam- 172) with median follow up of 4.2 years (IQR 2.9-6.4 years); 306 (23.1%) had CC/IDC on biopsy with 207 (20.9%) BCR and 154 (11.6%) events (metastases/death). Addition of CC/IDC improved stratification in CAPRA scores 3 to 5 for BCR-FS (c-index increase 0.633-0.658, P < .001) and scores 6-10 for EFS (c-index increase 0.653-0.697, P < .001). For NCCN, all risk groups apart from score 1 to 2 showed improvement in BCR-FS (c-index increase 0.599-0.636, P < 0.001) and EFS prediction (c-index increase 0.648-0.697, P < .001). Sub-analysis of grade group (GG) 2 biopsies showed similar findings. The retrospective nature and inclusion of cases only reported by genitourinary pathologists are study limitations.
The clinical benefit of the addition of CC/IDC to both CAPRA and NCCN pretreatment tools was validated in 3 cohorts, including the subset of biopsy GG2 prostate cancer patients.
Including additional pathologic features to existing pretreatment, clinical decision making tools improves the ability to predict prostate cancer recurrence, cancer spread and death of disease.
治疗前分层工具有助于前列腺癌的临床决策。迄今为止，尚无工具纳入前列腺导管内癌（IDC）或筛状模式4（CC）等公认的常规报告的不良预后病理特征。
评估添加CC和/或IDC对前列腺癌风险评估（CAPRA）和美国国立综合癌症网络（NCCN）工具预测多个患者队列无生化复发生存期（BCR-FS）和无事件生存期（EFS）的影响。
设计、设置和参与者：来自多伦多、威斯康星和鹿特丹机构的配对前列腺活检和根治性前列腺切除术。所有活检均记录CC/IDC的存在与否。
使用Cox比例风险模型、方差分析和Harrell一致性指数评估与预后的关系。
我们纳入了1326例患者（多伦多612例、威斯康星542例、鹿特丹172例），中位随访时间为4.2年（四分位间距2.9 - 6.4年）；306例（23.1%）活检有CC/IDC，其中207例（20.9%）发生BCR事件，154例（11.6%）发生转移/死亡事件）。添加CC/IDC可改善CAPRA评分3至5组的BCR-FS分层（c指数从0.633提高到0.658，P < 0.001）以及评分6至10组EFS分层（c指数从0.653提高到0.697，P < 0.001）。对于NCCN，除1至2分风险组外，所有风险组的BCR-FS（c指数从0.599提高到0.636，P < 0.001）和EFS预测（c指数从0.648提高到0.697，P < 0.00）均有改善。2级活检的亚组分析显示了类似结果。研究局限性在于其回顾性性质以及仅纳入了泌尿生殖病理学家报告的病例。
在3个队列中，包括活检2级前列腺癌患者亚组，验证了在CAPRA和NCCN治疗前工具中添加CC/IDC的临床益处。
在现有治疗前临床决策工具中纳入额外的病理特征可提高预测前列腺癌复发、癌症扩散和疾病死亡的能力。
