Architectural Heterogeneity and Cribriform Pattern Predict Adverse Clinical Outcome for Gleason Grade 4 Prostatic Adenocarcinoma
Fei Dong, Yang Ping, Chaofu Wang, Shulin Wu, Yu Xiao, W Scott McDougal, Robert H Young, Chin-Lee Wu. Massachusetts General Hospital, Boston, MA
Background: Gleason grade 4 defines a group of prostatic adenocarcinomas with a variety of architectural patterns. The most common patterns recognized by the 2005 International Society of Urological Pathology consensus conference are fused glands, poorly defined glands, and cribriform glands. The relative contribution to clinical prognosis by these distinct architectural patterns of grade 4 adenocarcinoma is unknown.
Design: 206 consecutive radical prostatectomy cases of prostatic adenocarcinoma with the highest Gleason grade of 4 at a single institution over a 5.5 year period (1992-1997) were retrospectively reviewed. The presence of fused glands, poorly defined glands, and cribriform glands and the predominant grade 4 pattern were recorded for each case. Biochemical recurrence was used as the primary endpoint, with a median postoperative biochemical followup of 5.7 years.
Results: The most common Gleason grade 4 pattern identified was fused glands (162 of 206, 78%). Among the three patterns, patients with cribriform glands had lower rates of biochemical disease free survival (68% vs 79% at 5 years, log-rank p = 0.03). The majority of patients (165 of 206, 80%) had more than one grade 4 architectural pattern. Patients with all three architectural patterns had lower rates of biochemical disease free survival (66% vs 75% at 5 years, log-rank p = 0.02).
Conclusions: The number and type of architectural patterns within Gleason grade 4 prostatic adenocarcinoma provide additional prognostic information for patients after radical prostatectomy. Subclassification of grade 4 adenocarcinoma may have clinical value for prognosis and management.
Category: Genitourinary (including renal tumors)
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 82, Tuesday Morning