Wang Binyu, Fu Yao, Chen Mengxia, Peng Shan, Marra Giancarlo, Zhuang Junlong, Zhang Shiwei, Guo Hongqian, Qiu Xuefeng
Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China; Institute of Urology, Nanjing University, Nanjing, China.
Department of Pathology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
Urol Oncol. 2024 Mar;42(3):67.e9-67.e15. doi: 10.1016/j.urolonc.2023.11.018. Epub 2024 Jan 17.
To explore the potential association between the presence of intraductal carcinoma of the prostate (IDC-P) on biopsy and pathologic response of primary tumor to neoadjuvant therapy in patients with high-risk prostate cancer.
Eighty-five patients with high-risk localized/locally advanced prostate cancer (CaP) who were given 6-month neoadjuvant therapies of androgen deprivation therapy plus docetaxel or abiraterone prior to radical prostatectomy in 2 prospective trials were included in this study. The presence of IDC-P in biopsy pathology was rereviewed by 2 experienced pathologists. Favorable pathologic response was defined as pathologic complete response or minimal residual disease <5 mm on whole-mount histopathology. Characteristics of clinical and biopsy pathology variables were included in univariate and multivariate logistic regression analyses to identify risk factors for the prediction of favorable pathologic response on final pathology.
IDC-P was identified to be present on biopsy pathology of 35 patients (41.2%) while favorable pathologic responses were confirmed in 25 patients (29.4%). Initial prostate-specific antigen (PSA) (OR 3.592, 95% CI 1.176-10.971, P = 0.025) and the presence of IDC-P on biopsy pathology (OR 3.837, 95% CI 1.234-11.930, P = 0.020) were found to be significantly associated with favorable pathologic response in multivariate logistic regression analysis.
IDC-P on biopsy pathology was found to be an independent risk factor to predict a poor pathology response of primary CaP to neoadjuvant therapies.
探讨活检时前列腺导管内癌（IDC-P）的存在与高危前列腺癌患者原发肿瘤对新辅助治疗的病理反应之间的潜在关联。
本研究纳入了85例高危局限性/局部进展性前列腺癌（CaP）患者，这些患者在两项前瞻性试验中，于根治性前列腺切除术前行6个月的雄激素剥夺治疗联合多西他赛或阿比特龙新辅助治疗。由2名经验丰富的病理学家重新审查活检病理中IDC-P的存在情况。良好的病理反应定义为病理完全缓解或在全层组织病理学上最小残留病灶<5 mm。临床和活检病理变量的特征纳入单因素和多因素逻辑回归分析，以确定预测最终病理良好病理反应的危险因素。
35例患者（41.2%）的活检病理中发现存在IDC-P，而25例患者（29.4%）证实有良好的病理反应。在多因素逻辑回归分析中，发现初始前列腺特异性抗原（PSA）（OR 3.592，95%CI 1.176 - 10.971，P = 0.025）和活检病理中IDC-P的存在（OR 3.837，95%CI 1.234 - 11.930，P = 0.020）与良好的病理反应显著相关。
活检病理中的IDC-P被发现是预测原发性CaP对新辅助治疗病理反应不佳的独立危险因素。
