Rubin M A, de La Taille A, Bagiella E, Olsson C A, O'Toole K M
Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
Am J Surg Pathol. 1998 Jul;22(7):840-8. doi: 10.1097/00000478-199807000-00006.
Cribriform neoplasia of the prostate can be recognized easily. However, controversy persists regarding terminology, particularly with the intraductal spread of cribriform neoplasia; some consider this "intraductal carcinoma," whereas consensus meetings defined these lesions as high-grade cribriform prostatic intraepithelial neoplasia (HGCP). This study attempts to identify the incidence and clinical significance of HGCP and cribriform carcinoma (CC) by evaluating 114 radical prostatectomy specimens. Cases were divided into three histologic groups for statistical analysis: (1) pure acinar carcinoma: infiltrating acinar carcinoma without evidence of cribriform neoplasia; (2) CC: acinar carcinoma with CC; and (3) HGCP: acinar carcinoma with HGCP. High-grade cribriform prostatic intraepithelial neoplasia was defined as the presence of neoplastic cells spanning the entire lumen in a cribriform configuration in which a basal cell layer could be shown by immunohistochemistry. Similar areas in which no basal cell layer could be seen were diagnosed as CC. The incidence of cribriform neoplasia was 38% (43 of 114). The incidences of HGCP and CC were 13% (15 of 114) and 25% (28 of 114), respectively. Univariate analysis showed a strong association between HGCP and CC both and several preoperative and final pathology results, including digital rectal examination, pathology tumor stage, extraprostatic extension, surgical margin positivity, high Gleason sum (GS), and high tumor volume. Kaplan-Meier analysis showed HGCP to have a 61% cumulative prostate-specific antigen (PSA) failure rate in contrast with CC and pure acinar cancer, which had cumulative PSA failure rates of 15% and 13%, respectively (p = 0.0001, log-rank test). Multivariate Cox's proportional-hazards analysis found preoperative serum PSA, GS, tumor stage, and volume to be important predictors of PSA failure. In a second regression model that included serum PSA, GS, and pathology tumor stage, HGCP was an independent predictor of PSA failure. Both HGCP and CC are closely associated with several poor prognostic indicators, including advanced pathology tumor stage, a high GS, and serum PSA. Multivariate analysis showed HGCP as an independent prognostic indicator. The close association between high tumor volume and HGCP supports the theory that the development of HGCP is a late event in tumor progression, more compatible with the intraductal spread of tumor than dysplasia.
前列腺筛状瘤变很容易识别。然而，关于术语仍存在争议，尤其是筛状瘤变的导管内扩散；一些人认为这是“导管内癌”，而共识会议将这些病变定义为高级别筛状前列腺上皮内瘤变（HGCP）。本研究试图通过评估114份前列腺根治性切除术标本，来确定HGCP和筛状癌（CC）的发生率及临床意义。病例分为三个组织学组进行统计分析：（1）单纯腺泡癌：浸润性腺泡癌，无筛状瘤变证据；（2）CC：伴有CC的腺泡癌；（3）HGCP：伴有HGCP的腺泡癌。高级别筛状前列腺上皮内瘤变定义为肿瘤细胞以筛状结构跨越整个管腔，免疫组化可显示基底细胞层。未见基底细胞层的类似区域诊断为CC。筛状瘤变的发生率为38%（114例中的43例）。HGCP和CC的发生率分别为13%（114例中的15例）和25%（114例中的28例）。单因素分析显示HGCP和CC均与多项术前及最终病理结果密切相关，包括直肠指检、病理肿瘤分期、前列腺外侵犯、手术切缘阳性、高Gleason评分（GS）和高肿瘤体积。Kaplan-Meier分析显示，HGCP的前列腺特异性抗原（PSA）累积失败率为61%，而CC和单纯腺泡癌的PSA累积失败率分别为15%和13%（p = 0.0001，对数秩检验）。多因素Cox比例风险分析发现术前血清PSA、GS、肿瘤分期和体积是PSA失败的重要预测因素。在包含血清PSA、GS和病理肿瘤分期的第二个回归模型中，HGCP是PSA失败的独立预测因素。HGCP和CC均与多项不良预后指标密切相关，包括晚期病理肿瘤分期、高GS和血清PSA。多因素分析显示HGCP是独立的预后指标。高肿瘤体积与HGCP之间的密切关联支持了这样一种理论，即HGCP的发生是肿瘤进展中的晚期事件，与肿瘤的导管内扩散比发育异常更相符。
