title: Digital quantification of five high-grade prostate cancer patterns, including the cribriform pattern, and their association with adverse outcome.
abstract: Proper grading of the cribriform prostate cancer pattern has not previously been supported by outcome-based evidence. Among 153 men who underwent radical prostatectomy, 76 with prostate-specific antigen (PSA) failure (≥0.2 ng/mL [0.2 μg/L]) were matched to 77 without failure. Frequencies of high-grade patterns included fused small acini, 83.7%; papillary, 52.3%; large cribriform, 37.9%; small (≤12 lumens) cribriform, 17.0%; and individual cells, 22.9%. A cribriform pattern was present in 61% (46/76) of failures but 16% (12/77) of nonfailures (P < .0001). Multivariate analysis showed the cribriform pattern had the highest odds ratio for PSA failure, 5.89 (95% confidence interval, 2.53-13.70; P < .0001). The presence of both large and small cribriform patterns was significantly linked to failure. The cumulative odds ratio of failure per added square millimeter of cribriform pattern was 1.173 (P = .008), higher than for any other pattern. All 8 men with a cribriform area sum of 25 mm(2) or more had failure (range, 33-930). Regrading cribriform cancer as Gleason 5 improved the grade association with failure, although half of all cases with individual cells also had a cribriform pattern, precluding a precise determination of the independent importance of the latter. The cribriform pattern has particularly adverse implications for outcome.
authors.affiliation: Department of Pathology, University of Colorado, Denver School of Medicine, Aurora, CO 80045, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Iczkowski
authors.forename: Kathleen C
authors.initials: KC
authors.lastname: Torkko
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Kotnis
authors.forename: R Storey
authors.initials: RS
authors.lastname: Wilson
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Wheeler
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Abeyta
authors.forename: Francisco G
authors.initials: FG
authors.lastname: La Rosa
authors.forename: Shelly
authors.initials: S
authors.lastname: Cook
authors.forename: Priya N
authors.initials: PN
authors.lastname: Werahera
authors.forename: M Scott
authors.initials: MS
authors.lastname: Lucia
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011467:Prostate / Q000473:pathology* / Q000601:surgery; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome