[926] Morphologic Features of 184 Gleason Score (GS) 7 Prostate Cancers (PC) with Regional Lymph Node Metastases (LN+) at Radical Prostatectomy (RP)

Oleksandr N Kryvenko, Nilesh Gupta, Daniel Schultz, Juan Gomez, Nilam Virani, Zhaoli Lane, Jonathan I Epstein. Henry Ford Hospital, Detroit; University of Michigan, Ann Arbor; The Johns Hopkins Hospital, Baltimore

Background: Only a small percentage of GS7 PC at RP has LN+ and little is known about the pathological findings associated with LN+ in these cases.
Design: We analyzed 184 GS7 LN+ RPs from 2 institutions (2000-2011). A 1:1 Gleason and stage-matched control group without LN metastasis (LN-) was used. Remote tumor foci were defined as satellites with the same morphology as in dominant tumor; otherwise they were interpreted as multifocal.
Results: The LN+ group included GS347 (n=64), GS437 (n=66), GS347 with tertiary 5 (n=10), and GS437 with tertiary 5 (n=44). Pathologic stages were: pT2 (n=16), pT3a (n=77), pT3b (n=91). No difference in age was seen between LN+ and LN- cases. Mean preoperative PSA was higher in LN+ (12.2) vs LN- (8.1) cases, p=0.001. Mean percentage of positive biopsy cores was 59.1 % in LN+ compared to 42.9 % in LN-, p=0.0001. LN+ cases showed more non-focal extraprostatic extension (EPE) than LN- (89% vs. 68%, p=0.0001). LN+ cases showed more GS4 poorly formed and cribriform pattern; glomeruloid, fused, and mucinous GS4 was more typical for LN- cases (all p<0.05). pT3b LN+ cases showed extensive SV invasion with EPE and lymphovascular invasion (LVI) in SV, in LN- cases tumor invaded SV focally without LVI in SV. Graded subjectively as 1-3, nuclear size (2.03 vs 1.63, p=0.0001), nucleolar size (1.63 vs 1.45, p=0.002) and distribution (1.64 vs 1.45, p=0.005) varied in LN+ vs. LN-; no difference in nuclear pleomorphism was seen. Other morphologic findings are in table (IDC = intraductal spread).

 Prostate Weight (p=0.008)Number of LNs (p<0.0001)Tumor Volume (p<0.0001)LVI (p<0.00001)IDC (p<0.0001)pT3a/pT3b (p<0.0001)Satellites (p=0.002)
LN+13.4 gms.13.428.9%79.3%42.4%77/9112.5
LN-9.4 gms.9.414.8%38.9%21.2%142/273.9

Conclusions: Within GS7, there are significant differences in cases with LN+ vs. LN- in preoperative PSA, percentage of positive cores, number of LN analyzed, tumor volume, morphology of pattern 4, stage, LVI, intraductal spread, satellite tumor foci, nuclear enlargement, and size and distribution of macronucleoli. These variables may be worthwhile to assess as prognostic markers in GS7 disease on biopsy (i.e. Gleason 4 morphology, IDC, cytology) or at RP (all variables) in men without LN dissection or LN-. This study also adds to the growing body of evidence on the adverse prognosis of IDC.
Category: Genitourinary (including renal tumors)

Wednesday, March 21, 2012 9:30 AM

Poster Session V # 116, Wednesday Morning


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