Addition of cribriform pattern 4 and intraductal prostatic carcinoma into the CAPRA-S tool improves post-radical prostatectomy patient stratification in a multi-institutional cohort

Ngoc-Nhu Jennifer Nguyen; Kristen Liu; Katherine Lajkosz; Kenneth A Iczkowski; Theodorus H van der Kwast; Michelle R Downes

doi:10.1136/jcp-2023-209222

Addition of cribriform pattern 4 and intraductal prostatic carcinoma into the CAPRA-S tool improves post-radical prostatectomy patient stratification in a multi-institutional cohort

J Clin Pathol. 2024 Feb 20:jcp-2023-209222. doi: 10.1136/jcp-2023-209222. Online ahead of print.

Authors

Ngoc-Nhu Jennifer Nguyen¹, Kristen Liu², Katherine Lajkosz³, Kenneth A Iczkowski², Theodorus H van der Kwast^{1

4}, Michelle R Downes^{5

6}

Affiliations

¹ Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
² Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
³ Department of Biostatistics, University Health Network, Toronto, Ontario, Canada.
⁴ Department of Pathology, University Health Network, Toronto, Ontario, Canada.
⁵ Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada michelle.downes@sunnybrook.ca.
⁶ Department of Anatomic Pathology, Precision Diagnostics & Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

PMID: 38378247
DOI: 10.1136/jcp-2023-209222

Abstract

Aims: Pre-surgical risk classification tools for prostate cancer have shown better patient stratification with the addition of cribriform pattern 4 (CC) and intraductal prostatic carcinoma (IDC) identified in biopsies. Here, we analyse the additional prognostic impact of CC/IDC observed in prostatectomies using Cancer of Prostate Risk Assessment post-surgical (CAPRA-S) stratification.

Methods: A retrospective cohort of treatment-naïve radical prostatectomy specimens from three North American academic institutions (2010-2018) was assessed for the presence of CC/IDC. Patients were classified, after calculating the CAPRA-S scores, into low-risk (0-2), intermediate-risk (3-5) and high-risk (6-12) groups. Kaplan-Meier curves were created to estimate biochemical recurrence (BCR)-free survival. Prognostic performance was examined using Harrell's concordance index, and the effects of CC/IDC within each risk group were evaluated using the Cox proportional hazards models.

Results: Our cohort included 825 prostatectomies (grade group (GG)1, n=94; GG2, n=475; GG3, n=185; GG4, n=13; GG5, n=58). CC/IDC was present in 341 (41%) prostatectomies. With a median follow-up of 4.2 years (range 2.9-6.4), 166 (20%) patients experienced BCR. The CAPRA-S low-risk, intermediate-risk and high-risk groups comprised 357 (43%), 328 (40%) and 140 (17%) patients, and discriminated for BCR-free survival (p<0.0001). For CAPRA-S scores 3-5, the addition of CC/IDC status improved stratification for BCR (HR 2.27, 95% CI 1.41 to 3.66, p<0.001) and improved the overall c-index (0.689 vs 0.667, analysis of variance p<0.001).

Conclusion: The addition of CC/IDC into the CAPRA-S classification significantly improved post-radical prostatectomy patient stratification for BCR among the intermediate-risk group (CAPRA-S scores 3-5). The reporting of CC and IDC should be included in future prostate cancer stratification tools for improved outcome prediction.

Keywords: Morphological and Microscopic Findings; PROSTATE; Urologic Neoplasms.