Cribriform glands are associated with worse outcome than other pattern 4
subtypes: A study of prognostic and clinicopathologic characteristics of
prostate adenocarcinoma with an emphasis on grade groups
Abstract
Aim: Although prostate adenocarcinoma is the most common cancer in men,
survival is quite high and with the help of histopathological
examination using the updated classification, patient management
strategies are developing. We aimed to evaluate the correlation between
the histopathological features and biochemical recurrence (BCR) in
patients who underwent radical prostatectomy (RP) using the new
classification. Methods: A total of 285 prostate adenocarcinoma cases
that underwent RP between January 2009 and December 2017 and followed up
for at least 3 months were included in the study. The cases were
re-evaluated according to WHO-ISUP 2016 classification and the findings
were recorded. Results: The mean age was 63,4 years. Gleason scores of
the cases were as follows: 3+3 144 cases (50.5%), 3+4 81 cases
(28.4%), 4+3 28 cases (9.8%), 4+4 7 cases (2.5%) , 3+5 6 cases
(2.1%), 5+3 2 cases (0.7%), 4+5 17 cases (6%). There were 198
(69,5%) pT2, 54 (18,9%) pT3a and 33 (11,6%) pT3b cases. The mean
follow-up time was 44,1 months and BCR was detected in 97 cases (34%).
The relationship between the Group Grades and BCR was statistically
significant. BCR rate increased as the tumor volume and the percentage
of pattern 4 increased (p<0.001).There was a significant
correlation between preoperative PSA value, extraprostatic extension,
seminal vesicle invasion, surgical margin positivity, tumor volume,
pattern 4 percentage, presence of cribriform glands and BCR and
recurrence-free survival in both univariate and multivariate analysis
and recurrence-free survival was also affected by these parameters.
Among the morphological subtypes of Pattern 4, recurrence-free survival
decreased as the incidence of cribriform glands increased (p
<0.001). Conclusion: Histopathological evaluation is important
in predicting BCR in prostate adenocarcinoma, the Group Grade system
seems to be helpful in this regard. More studies are needed to prove the
relatively worse prognostic effect of cribriform glands.