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)|