BACKGROUND: Intraductal carcinoma (IDC) of prostate is a distinct entity associated with higher Gleason score and poor prognosis.
The prognostic significance of large cribriform Gleason pattern 4 (LC) in conjunction with IDC has not been previously investigated. The aim of our study was to determine the impact of IDC and LC on biochemical recurrence-free rate (bRFR) in a contemporary prostatectomy cohort.
METHODS: Prostate cancers of 246 prostatectomies, median follow-up 130.6months, were graded with the International Society of Urological Pathology (ISUP) 2005 modified Gleason score (GS) and assessed for the presence of LC and/or IDC. In 57 cases with LC and/or IDC, immunostaining was performed to distinguish LC and IDC. The Kaplan-Meier (KM) method was used to estimate 5-year bRFR probabilities. Cox proportional hazards models were used to generate hazard ratios (HRs) and 95% confidence intervals (CIs).
RESULTS: Multivariable analysis showed that the presence of any amount of LC or IDC had a highly significant prognostic effect on bRFR (HR 2.98, 95% CI: 1.68-5.28, p=0.0002) after adjusting for GS, surgical margin status and pathological stage. Although IDC alone tended to be associated with a worse prognosis, LC and IDC did not appear to be associated with a difference in bRFR when analysed separately.
CONCLUSION: We demonstrate that the presence of any amount of LC/IDC is a significant prognostic factor after adjusting for Gleason score and T stage in determining patient outcome and we advocate including the presence of either in routine pathology reporting.
Written by:
Trudel D, Downes MR, Sykes J, Kron KJ, Trachtenberg J, van der Kwast TH. Are you the author?
Dept. of Pathology and Laboratory Medicine, University Health Network, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada; Dept. of Biostatistics, Princess Margaret Cancer Center, University Health Network, 610 University Avenue, Toronto, ON M5T 2M9, Canada; Dept. of Urology, University Health Network, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada.
Reference: Eur J Cancer. 2014 Apr 3. pii: S0959-8049(14)00252-4.
doi: 10.1016/j.ejca.2014.03.009
PubMed Abstract
PMID: 24703897
UroToday.com Prostate Cancer Section
