Significance and outcome of nuclear anaplasia and mitotic index in prostatic adenocarcinomas.
The Gleason grading system measures architectural differentiation and disregards nuclear atypia and the cell proliferation index. Several studies have reported that nuclear grade and mitotic index (MI) are prognostically useful.



This study included 232 radical prostatectomy specimens. Nuclear anaplasia (NA) was determined on the basis of nucleomegali (at least 20µm); vesicular chromatin; eosinophilic macronucleoli, nuclear lobulation, and irregular thickened nuclear membranei. The proportion of area of NA was recorded in each tumor in 10% increments. The MI was defined as the number of mitotic figures in 10 consecutive high-power fields (HPF).



In univariate analysis, significant differences included associations between biochemical prostate-specific antigen recurrence (BCR) and Gleason score, extraprostatic extension, positive surgical margin, the presence of high-pathologic stage, NA≥10% of tumor area, MI≥3/10 HPF, and preoperative prostate-specific antigen. In a stepwise Cox regression model, a positive surgical margin, the presence of a NA≥10% of tumor area, and a MI of≥3/10 HPF were independent predictors of BCR after radical prostatectomy. NA≥10% of tumor area appeared to have a stronger association with outcome than MI≥3/10 HPF, as still associated with BCR when Gleason score was in the model.



The results of our study showed that, in addition to the conventional Gleason grading system, NA, and MI are useful prognostic parameters while evaluating long-term prognosis in prostatic adenocarcinoma.
Pathology Department, Umraniye Education & Research Hospital Umraniye, Istanbul, Turkey. Electronic address: gozkir@yahoo.com.
Gozde
G
Kır
Pathology Department, Umraniye Education & Research Hospital Umraniye, Istanbul, Turkey.
Billur Cosan
BC
Sarbay
Urology Department, Umraniye Education & Research Hospital Umraniye, Istanbul, Turkey.
Eyup
E
Gumus
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000708:Anaplasia / Q000473:pathology; D019540:Area Under Curve; D002467:Cell Nucleus / Q000473:pathology*; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008940:Mitotic Index; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000097:blood*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D011379:Prognosis; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D012372:ROC Curve
D017430:Prostate-Specific Antigen
Gleason score; Prostate; Prostate-specific antigen