Comedonecrosis Gleason pattern 5 is associated with worse clinical outcome in operated prostate cancer patients
Individual growth patterns and cribriform architecture are increasingly considered in risk stratification and clinical decision-making in men with prostate cancer. Our objective was to establish the prognostic value of individual Gleason 5 patterns in a radical prostatectomy (RP) cohort. We reviewed...
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| Veröffentlicht in: | Modern pathology 2021-11, Vol.34 (11), p.2064-2070 |
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| creator | Hansum, Tim Hollemans, Eva Verhoef, Esther I. Bangma, Chris H. Rietbergen, John Osanto, Susanne Pelger, Rob C.M. van Wezel, Tom van der Poel, Henk Bekers, Elise Helleman, Jozien Remmers, Sebastiaan van Leenders, Geert J. L.H. |
| description | Individual growth patterns and cribriform architecture are increasingly considered in risk stratification and clinical decision-making in men with prostate cancer. Our objective was to establish the prognostic value of individual Gleason 5 patterns in a radical prostatectomy (RP) cohort. We reviewed 1064 RPs and recorded Grade Group (GG), pT-stage, surgical margin status, Gleason 4 and 5 growth patterns as well as intraductal carcinoma. The clinical endpoints were biochemical recurrence and post-operative distant metastasis. Gleason pattern 5 was present in 339 (31.9%) RPs, of which 47 (4.4%) presented as primary, 166 (15.6%) as secondary, and 126 (11.8%) as tertiary pattern. Single cells/cords were present in 321 (94.7%) tumors with Gleason pattern 5, solid fields in 90 (26.5%), and comedonecrosis in invasive carcinoma in 32 (9.4%) tumors. Solid fields demonstrated either a small nested morphology (n = 50, 14.7%) or medium to large solid fields (n = 61, 18.0%). Cribriform architecture was present in 568 (53.4%) RPs. Medium to large solid fields and comedonecrosis coincided with cribriform architecture in all specimens, and were not observed in cribriform-negative cases. In multivariable analysis adjusted for Prostate-Specific Antigen, pT-stage, GG, surgical margin status and lymph node metastases, cribriform architecture (Hazard Ratio (HR) 9.9; 95% Confidence Interval (CI) 3.9–25.5, P < 0.001) and comedonecrosis (HR 2.1, 95% CI 1.2–3.7, P = 0.01) were independent predictors for metastasis-free survival, while single cells/cords (HR 1.2; 95% CI 0.7–1.8, P = 0.55) and medium to large solid fields (HR 1.6, 95% CI 0.9–2.7, P = 0.09) were not. In conclusion, comedonecrosis in invasive carcinoma is an independent prognostic Gleason 5 pattern for metastasis-free survival after RP. These data support the current recommendations to routinely include cribriform pattern in pathology reports and indicate that comedonecrosis should also be commented on. |
| doi_str_mv | 10.1038/s41379-021-00860-4 |
| format | Article |
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L.H.</creator><creatorcontrib>Hansum, Tim ; Hollemans, Eva ; Verhoef, Esther I. ; Bangma, Chris H. ; Rietbergen, John ; Osanto, Susanne ; Pelger, Rob C.M. ; van Wezel, Tom ; van der Poel, Henk ; Bekers, Elise ; Helleman, Jozien ; Remmers, Sebastiaan ; van Leenders, Geert J. L.H.</creatorcontrib><description>Individual growth patterns and cribriform architecture are increasingly considered in risk stratification and clinical decision-making in men with prostate cancer. Our objective was to establish the prognostic value of individual Gleason 5 patterns in a radical prostatectomy (RP) cohort. We reviewed 1064 RPs and recorded Grade Group (GG), pT-stage, surgical margin status, Gleason 4 and 5 growth patterns as well as intraductal carcinoma. The clinical endpoints were biochemical recurrence and post-operative distant metastasis. Gleason pattern 5 was present in 339 (31.9%) RPs, of which 47 (4.4%) presented as primary, 166 (15.6%) as secondary, and 126 (11.8%) as tertiary pattern. Single cells/cords were present in 321 (94.7%) tumors with Gleason pattern 5, solid fields in 90 (26.5%), and comedonecrosis in invasive carcinoma in 32 (9.4%) tumors. Solid fields demonstrated either a small nested morphology (n = 50, 14.7%) or medium to large solid fields (n = 61, 18.0%). Cribriform architecture was present in 568 (53.4%) RPs. Medium to large solid fields and comedonecrosis coincided with cribriform architecture in all specimens, and were not observed in cribriform-negative cases. In multivariable analysis adjusted for Prostate-Specific Antigen, pT-stage, GG, surgical margin status and lymph node metastases, cribriform architecture (Hazard Ratio (HR) 9.9; 95% Confidence Interval (CI) 3.9–25.5, P < 0.001) and comedonecrosis (HR 2.1, 95% CI 1.2–3.7, P = 0.01) were independent predictors for metastasis-free survival, while single cells/cords (HR 1.2; 95% CI 0.7–1.8, P = 0.55) and medium to large solid fields (HR 1.6, 95% CI 0.9–2.7, P = 0.09) were not. In conclusion, comedonecrosis in invasive carcinoma is an independent prognostic Gleason 5 pattern for metastasis-free survival after RP. These data support the current recommendations to routinely include cribriform pattern in pathology reports and indicate that comedonecrosis should also be commented on.</description><identifier>ISSN: 0893-3952</identifier><identifier>EISSN: 1530-0285</identifier><identifier>DOI: 10.1038/s41379-021-00860-4</identifier><identifier>PMID: 34175896</identifier><language>eng</language><publisher>New York: Elsevier Inc</publisher><subject>13 ; 13/51 ; 14/63 ; 692/699/2768/1753/466 ; 692/699/67/589/466 ; Adenocarcinoma - pathology ; Adenocarcinoma - surgery ; Aged ; Cancer surgery ; Carcinoma, Intraductal, Noninfiltrating - pathology ; Carcinoma, Intraductal, Noninfiltrating - surgery ; Clinical outcomes ; Decision making ; Disease-Free Survival ; Follow-Up Studies ; Growth patterns ; Humans ; Invasiveness ; Kaplan-Meier Estimate ; Laboratory Medicine ; Lymph nodes ; Lymphatic Metastasis ; Male ; Medicine ; Medicine & Public Health ; Metastases ; Metastasis ; Middle Aged ; Neoplasm Grading ; Neoplasm Recurrence, Local - pathology ; Pathology ; Prognosis ; Proportional Hazards Models ; Prostate cancer ; Prostate-specific antigen ; Prostate-Specific Antigen - blood ; Prostatectomy ; Prostatic Neoplasms - pathology ; Prostatic Neoplasms - surgery ; Tumors ; Urological surgery</subject><ispartof>Modern pathology, 2021-11, Vol.34 (11), p.2064-2070</ispartof><rights>2021 The Authors</rights><rights>The Author(s) 2021</rights><rights>2021. The Author(s).</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c527t-73b4b0aa3e904a9c18fd1bac305bb29a5f49920db607f15a7acd51ef70328d13</citedby><cites>FETCH-LOGICAL-c527t-73b4b0aa3e904a9c18fd1bac305bb29a5f49920db607f15a7acd51ef70328d13</cites><orcidid>0000-0002-4413-5623 ; 0000-0001-5773-7730 ; 0000-0001-6328-6462 ; 0000-0003-2406-5370 ; 0000-0002-2734-0254 ; 0000-0003-2176-9102</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2581615852?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34175896$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hansum, Tim</creatorcontrib><creatorcontrib>Hollemans, Eva</creatorcontrib><creatorcontrib>Verhoef, Esther I.</creatorcontrib><creatorcontrib>Bangma, Chris H.</creatorcontrib><creatorcontrib>Rietbergen, John</creatorcontrib><creatorcontrib>Osanto, Susanne</creatorcontrib><creatorcontrib>Pelger, Rob C.M.</creatorcontrib><creatorcontrib>van Wezel, Tom</creatorcontrib><creatorcontrib>van der Poel, Henk</creatorcontrib><creatorcontrib>Bekers, Elise</creatorcontrib><creatorcontrib>Helleman, Jozien</creatorcontrib><creatorcontrib>Remmers, Sebastiaan</creatorcontrib><creatorcontrib>van Leenders, Geert J. L.H.</creatorcontrib><title>Comedonecrosis Gleason pattern 5 is associated with worse clinical outcome in operated prostate cancer patients</title><title>Modern pathology</title><addtitle>Mod Pathol</addtitle><addtitle>Mod Pathol</addtitle><description>Individual growth patterns and cribriform architecture are increasingly considered in risk stratification and clinical decision-making in men with prostate cancer. Our objective was to establish the prognostic value of individual Gleason 5 patterns in a radical prostatectomy (RP) cohort. We reviewed 1064 RPs and recorded Grade Group (GG), pT-stage, surgical margin status, Gleason 4 and 5 growth patterns as well as intraductal carcinoma. The clinical endpoints were biochemical recurrence and post-operative distant metastasis. Gleason pattern 5 was present in 339 (31.9%) RPs, of which 47 (4.4%) presented as primary, 166 (15.6%) as secondary, and 126 (11.8%) as tertiary pattern. Single cells/cords were present in 321 (94.7%) tumors with Gleason pattern 5, solid fields in 90 (26.5%), and comedonecrosis in invasive carcinoma in 32 (9.4%) tumors. Solid fields demonstrated either a small nested morphology (n = 50, 14.7%) or medium to large solid fields (n = 61, 18.0%). Cribriform architecture was present in 568 (53.4%) RPs. Medium to large solid fields and comedonecrosis coincided with cribriform architecture in all specimens, and were not observed in cribriform-negative cases. In multivariable analysis adjusted for Prostate-Specific Antigen, pT-stage, GG, surgical margin status and lymph node metastases, cribriform architecture (Hazard Ratio (HR) 9.9; 95% Confidence Interval (CI) 3.9–25.5, P < 0.001) and comedonecrosis (HR 2.1, 95% CI 1.2–3.7, P = 0.01) were independent predictors for metastasis-free survival, while single cells/cords (HR 1.2; 95% CI 0.7–1.8, P = 0.55) and medium to large solid fields (HR 1.6, 95% CI 0.9–2.7, P = 0.09) were not. In conclusion, comedonecrosis in invasive carcinoma is an independent prognostic Gleason 5 pattern for metastasis-free survival after RP. These data support the current recommendations to routinely include cribriform pattern in pathology reports and indicate that comedonecrosis should also be commented on.</description><subject>13</subject><subject>13/51</subject><subject>14/63</subject><subject>692/699/2768/1753/466</subject><subject>692/699/67/589/466</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Aged</subject><subject>Cancer surgery</subject><subject>Carcinoma, Intraductal, Noninfiltrating - pathology</subject><subject>Carcinoma, Intraductal, Noninfiltrating - surgery</subject><subject>Clinical outcomes</subject><subject>Decision making</subject><subject>Disease-Free Survival</subject><subject>Follow-Up Studies</subject><subject>Growth patterns</subject><subject>Humans</subject><subject>Invasiveness</subject><subject>Kaplan-Meier Estimate</subject><subject>Laboratory Medicine</subject><subject>Lymph nodes</subject><subject>Lymphatic Metastasis</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Neoplasm Grading</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Pathology</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Prostate cancer</subject><subject>Prostate-specific antigen</subject><subject>Prostate-Specific Antigen - blood</subject><subject>Prostatectomy</subject><subject>Prostatic Neoplasms - pathology</subject><subject>Prostatic Neoplasms - surgery</subject><subject>Tumors</subject><subject>Urological surgery</subject><issn>0893-3952</issn><issn>1530-0285</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kUtv1TAQhSMEoreFP8ACWWLDJuDnjS0hJHRFC1IlNt1bjjNpXeXawXZa9d8ztynlsejK1sx3znh8muYNox8YFfpjkUx0pqWctZTqLW3ls2bDlKBY0up5s6HaiFYYxY-a41KuKWVSaf6yORKSdUqb7aZJu7SHIUXwOZVQyNkErqRIZlcr5EgUwaIrJfngKgzkNtQrcptyAeKnEIN3E0lL9ehCQiRphnzPzWhX8Ua8ix7ywS9ArOVV82J0U4HXD-dJc3H69WL3rT3_cfZ99-W89Yp3te1EL3vqnABDpTOe6XFgvfOCqr7nxqlRGsPp0G9pNzLlOucHxWDsqOB6YOKk-bzazkuP-3kcnd1k5xz2Lt_Z5IL9txPDlb1MN1YrJtECDd4_GOT0c4FS7T4UD9PkIqSlWK6kMqZj4oC--w-9TkuOuB1Smm2Z0oojxVfq8NElw_j4GEbtIU67xmkxTnsfp5Uoevv3Go-S3_khIFagYCteQv4z-0nbT6sKMIGbgKriMR0PQ8jgqx1SeEr-C11wwUw</recordid><startdate>20211101</startdate><enddate>20211101</enddate><creator>Hansum, Tim</creator><creator>Hollemans, Eva</creator><creator>Verhoef, Esther I.</creator><creator>Bangma, Chris H.</creator><creator>Rietbergen, John</creator><creator>Osanto, Susanne</creator><creator>Pelger, Rob C.M.</creator><creator>van Wezel, Tom</creator><creator>van der Poel, Henk</creator><creator>Bekers, Elise</creator><creator>Helleman, Jozien</creator><creator>Remmers, Sebastiaan</creator><creator>van Leenders, Geert J. 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L.H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comedonecrosis Gleason pattern 5 is associated with worse clinical outcome in operated prostate cancer patients</atitle><jtitle>Modern pathology</jtitle><stitle>Mod Pathol</stitle><addtitle>Mod Pathol</addtitle><date>2021-11-01</date><risdate>2021</risdate><volume>34</volume><issue>11</issue><spage>2064</spage><epage>2070</epage><pages>2064-2070</pages><issn>0893-3952</issn><eissn>1530-0285</eissn><abstract>Individual growth patterns and cribriform architecture are increasingly considered in risk stratification and clinical decision-making in men with prostate cancer. Our objective was to establish the prognostic value of individual Gleason 5 patterns in a radical prostatectomy (RP) cohort. We reviewed 1064 RPs and recorded Grade Group (GG), pT-stage, surgical margin status, Gleason 4 and 5 growth patterns as well as intraductal carcinoma. The clinical endpoints were biochemical recurrence and post-operative distant metastasis. Gleason pattern 5 was present in 339 (31.9%) RPs, of which 47 (4.4%) presented as primary, 166 (15.6%) as secondary, and 126 (11.8%) as tertiary pattern. Single cells/cords were present in 321 (94.7%) tumors with Gleason pattern 5, solid fields in 90 (26.5%), and comedonecrosis in invasive carcinoma in 32 (9.4%) tumors. Solid fields demonstrated either a small nested morphology (n = 50, 14.7%) or medium to large solid fields (n = 61, 18.0%). Cribriform architecture was present in 568 (53.4%) RPs. Medium to large solid fields and comedonecrosis coincided with cribriform architecture in all specimens, and were not observed in cribriform-negative cases. In multivariable analysis adjusted for Prostate-Specific Antigen, pT-stage, GG, surgical margin status and lymph node metastases, cribriform architecture (Hazard Ratio (HR) 9.9; 95% Confidence Interval (CI) 3.9–25.5, P < 0.001) and comedonecrosis (HR 2.1, 95% CI 1.2–3.7, P = 0.01) were independent predictors for metastasis-free survival, while single cells/cords (HR 1.2; 95% CI 0.7–1.8, P = 0.55) and medium to large solid fields (HR 1.6, 95% CI 0.9–2.7, P = 0.09) were not. In conclusion, comedonecrosis in invasive carcinoma is an independent prognostic Gleason 5 pattern for metastasis-free survival after RP. These data support the current recommendations to routinely include cribriform pattern in pathology reports and indicate that comedonecrosis should also be commented on.</abstract><cop>New York</cop><pub>Elsevier Inc</pub><pmid>34175896</pmid><doi>10.1038/s41379-021-00860-4</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-4413-5623</orcidid><orcidid>https://orcid.org/0000-0001-5773-7730</orcidid><orcidid>https://orcid.org/0000-0001-6328-6462</orcidid><orcidid>https://orcid.org/0000-0003-2406-5370</orcidid><orcidid>https://orcid.org/0000-0002-2734-0254</orcidid><orcidid>https://orcid.org/0000-0003-2176-9102</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0893-3952 |
| ispartof | Modern pathology, 2021-11, Vol.34 (11), p.2064-2070 |
| issn | 0893-3952 1530-0285 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8514328 |
| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; ProQuest Central UK/Ireland; Alma/SFX Local Collection |
| subjects | 13 13/51 14/63 692/699/2768/1753/466 692/699/67/589/466 Adenocarcinoma - pathology Adenocarcinoma - surgery Aged Cancer surgery Carcinoma, Intraductal, Noninfiltrating - pathology Carcinoma, Intraductal, Noninfiltrating - surgery Clinical outcomes Decision making Disease-Free Survival Follow-Up Studies Growth patterns Humans Invasiveness Kaplan-Meier Estimate Laboratory Medicine Lymph nodes Lymphatic Metastasis Male Medicine Medicine & Public Health Metastases Metastasis Middle Aged Neoplasm Grading Neoplasm Recurrence, Local - pathology Pathology Prognosis Proportional Hazards Models Prostate cancer Prostate-specific antigen Prostate-Specific Antigen - blood Prostatectomy Prostatic Neoplasms - pathology Prostatic Neoplasms - surgery Tumors Urological surgery |
| title | Comedonecrosis Gleason pattern 5 is associated with worse clinical outcome in operated prostate cancer patients |
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