Prognostic impact of intraductal carcinoma and large cribriform carcinoma architecture after prostatectomy in a contemporary cohort.
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 130.6 months, 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.


CONCLUSIONS
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.
Dept. of Pathology and Laboratory Medicine, University Health Network, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada.
Dominique
D
Trudel
Dept. of Pathology and Laboratory Medicine, University Health Network, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada.
Michelle R
MR
Downes
Dept. of Biostatistics, Princess Margaret Cancer Center, University Health Network, 610 University Avenue, Toronto, ON M5T 2M9, Canada.
Jenna
J
Sykes
Dept. of Pathology and Laboratory Medicine, University Health Network, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada.
Ken J
KJ
Kron
Dept. of Urology, University Health Network, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada.
John
J
Trachtenberg
Dept. of Pathology and Laboratory Medicine, University Health Network, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada. Electronic address: Theodorus.vanderkwast@uhn.ca.
Theodorus H
TH
van der Kwast
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000368:Aged; D044584:Carcinoma, Ductal / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D011468:Prostatectomy / Q000401:mortality; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery
Biochemical recurrence; Cribriform pattern; Gleason grading; Intraductal carcinoma; Prostate