Neoplastic Retraction Clefting on Prostate Needle Biopsies: Is It a Prognostic Factor?
Wagner J Favaro, Athanase Billis, Valeria HA Cagnon, Luciana Meirelles, Leandro LLL Freitas, Betina D Lins, Joao FL Bonfito, Larissa BE Costa, Paola H Poletto. University of Campinas (Unicamp) School of Medicine, Campinas, SP, Brazil; Biology Institute, University of Campinas (Unicamp), Campinas, SP, Brazil
Background: Neoplastic periacinar retraction clefting (NPRC) is an additional criterion for the diagnosis of prostate adenocarcinoma, especially when prominent. A recent study showed that NPRC on surgical specimens from patients submitted to radical prostatectomy (RP) predicts time to biochemical recurrence (TBR) following surgery. We studied on prostate needle biopsies a possible prognostic value of NPRC.
Design: The study was based on 358 biopsies from patients submitted to RP. NPRC was considered as absent (grade 0), slight (grade 1), evident (grade 2), and intense (grade 3) according to the distance of the epithelium to the stroma. In cases with several grades present in the same biopsy it was considered the higher grade. Grading of NPRC was related to several clinicopathological variables: age, race, clinical stage, preoperative PSA, RP tumor extent using a semiquantitative point-count method, biopsy and surgical specimen Gleason score, pathologic stage, and surgical margin status. For statistics, we used the Kaplan-Meier product-limit analysis, and the Cox stepwise logistic regression model and the binary logistic regression for univariate and multivariate analyses.
Results: From the total of 358 biopsies, 49 (13,7%), 176 (49,2%), 127 (35,5%) e 6 (1,7%) biopsies showed grades 0, 1, 2 e 3, respectively. For statistical analysis we considered group 1 (grades 0 and 1) vs. group 2 (grades 2 and 3). There was no statistically significant difference comparing the 2 groups according to age (p=0.05), race (p=0.49), preoperative PSA (p=0.74), clinical (p=1.00) or pathologic stage (p=0.12), biopsy (p=0.72) or surgical specimen Gleason score (p=0.58), positive surgical margins (p=0.59) and TBR following surgery (log-rank, p=0.95). Tumor extent in the surgical specimen was significantly higher in group 2 (p=0.03). Group 2 was not significantly predictive of biochemical recurrence or TBR in univariate or multivariate analyses. Group 2 was significantly predictive of tumor extent in the surgical specimen in univariate (p=0.01) and multivariate analyses (p=0.04).
Conclusions: In our study, evident or intense neoplastic retraction clefting on prostate needle biopsies was associated with and significantly predictive of more extensive tumors in the surgical specimen of patients submitted to radical prostatectomy. It seems that retraction clefting is associated and more intense with tumor growth.
Category: Genitourinary (including renal tumors)
Monday, March 19, 2012 1:00 PM
Poster Session II # 186, Monday Afternoon