Highlights
- •Cribriform architecture includes cribriform pattern 4 and intraductal carcinoma.
- •Cribriform architecture in prostate cores strongly associate with nodal metastases.
- •Sampling of cribriform architecture carcinomas in biopsy tissue is critical.
Abstract
Aim
Lymph node metastases (pN1) at prostatectomy are infrequent but impact prognosis.
Traditional prostate nomograms assess age, serum prostatic-specific antigen (PSA),
clinical stage, and biopsy parameters to inform decisions on pelvic lymph node dissection.
The impact of intraductal carcinoma (IDC) and cribriform pattern 4 (CC) on nodal metastases
has yet to be explored.
Methods
Five hundred forty three radical prostatectomy cases were reviewed for International
Society of Urological Pathology (ISUP) grade, CC/IDC, T- and N-stage. Two hundred
seventy five cases had matched biopsies with age, serum PSA, CC/IDC and ISUP grade
recorded. The association of CC/IDC with pN1 in both prostatectomy and biopsy settings
was assessed using Fisher's exact test, as well as univariable (UVA) and multivariable
(MVA) logistic regression.
Results
In 543 men in whom a prostatectomy was performed, a nodal dissection was also available
in 340 (63%), and 37 (10.9%) of them had pN1 disease. ISUP grade, stage and CC/IDC
were significantly associated with pN1 (p < 0.001). UVA regression showed grade (p < 0.001,
odds ratio [OR]: 5.85), CC/IDC (p = 0.003, OR: 14.06) and T stage (p = 0.004, OR:
61.94) associated with pN1 as did MVA regression: grade (p = 0.010, OR: 2.81), CC/IDC
(p = 0.015, OR: 5.12) and T stage (p = 0.016, OR: 30.38). In 275 patients with matched
biopsies, a nodal dissection was performed in 197 (71.6%) and 20 (10.2%) patients
had pN1 disease. On UVA regression, grade (p < 0.001, OR: 6.33), CC/IDC (p = 0.013,
OR: 3.28), serum PSA (p = 0.001, OR: 1.08) and age (p = 0.047, OR: 1.07) were significant
for pN1 at prostatectomy. All parameters including specifically grade (p = 0.007,
OR: 5.35) and CC/IDC (p = 0.018, OR: 4.42) on biopsies predicted for pN1 by multivariate
analysis.
Conclusion
CC/IDC in prostatectomy and biopsy significantly associates with pN1. Incorporation
of CC/IDC status into preoperative nomograms may optimize patient selection for pelvic
nodal dissection.
Keywords
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Article info
Publication history
Published online: October 16, 2020
Accepted:
September 20,
2020
Received in revised form:
August 26,
2020
Received:
March 26,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
ScienceDirect
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- Editorial for Cribriform architecture prostatic adenocarcinoma in needle biopsy is a strong independent predictor for lymph node metastases in radical prostatectomy (M. Downes et al.) and Ductal variant prostate carcinoma is associated with a significantly shorter metastasis-free survival (K. Chow et al.)European Journal of CancerVol. 148
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