Significance of the cribriform morphology area ratio for biochemical recurrence in Gleason score 4 + 4 prostate cancer patients following robot-assisted radical prostatectomy

Kenji Shimodaira; Rie Inoue; Takeshi Hashimoto; Naoya Satake; Toshihide Shishido; Kazunori Namiki; Kazuharu Harada; Toshitaka Nagao; Yoshio Ohno

doi:10.1002/cam4.7086

Significance of the cribriform morphology area ratio for biochemical recurrence in Gleason score 4 + 4 prostate cancer patients following robot-assisted radical prostatectomy

Cancer Med. 2024 Mar;13(5):e7086. doi: 10.1002/cam4.7086.

Authors

Kenji Shimodaira¹, Rie Inoue², Takeshi Hashimoto¹, Naoya Satake¹, Toshihide Shishido¹, Kazunori Namiki¹, Kazuharu Harada³, Toshitaka Nagao², Yoshio Ohno¹

Affiliations

¹ Department of Urology, Tokyo Medical University, Tokyo, Japan.
² Anatomic Pathology, Tokyo Medical University, Tokyo, Japan.
³ Department of Health Data Science, Tokyo Medical University, Tokyo, Japan.

Abstract

Background: In prostate cancer, histological cribriform patterns are categorized as Gleason pattern 4, and recent studies have indicated that their size and percentage are associated with the risk of biochemical recurrence (BCR). However, these studies included a mixture of cases with various Gleason scores (GSs). We therefore examined the prognostic value of the area and percentage of cribriform patterns in patients with GS 4 + 4 prostate cancer.

Methods: We investigated 108 patients with GS 4 + 4 prostate cancer who underwent robot-assisted radical prostatectomy (RARP). After digitally scanning the hematoxylin and eosin-stained slides, we measured the area of the entire cancer and cribriform patterns. Predictive factors for BCR were explored using log-rank test and Cox proportional hazard model analyses.

Results: Sixty-seven (62.0%) patients had a cribriform pattern in RARP specimens, and 32 (29.6%) experienced BCR. The median total cancer area, cribriform pattern area, and percentage of cribriform pattern area (% cribriform) were 427.70 mm² (interquartile range [IQR], 171.65-688.53 mm² ), 8.85 mm² (IQR, 0-98.83 mm² ), and 2.44% (IQR, 0%-33.70%), respectively. Univariate analyses showed that higher preoperative serum prostate-specific antigen (PSA) levels, positive resection margins, advanced pathological T stage, extraprostatic extension, larger total cancer area, larger cribriform morphology area, and higher % cribriform values were significantly associated with BCR. A multivariate analysis demonstrated that the PSA level (hazard ratio [HR], 1.061; 95% confidence interval [CI], 1.011-1.113; p = 0.017) and % cribriform (HR, 1.018; 95% CI, 1.005-1.031; p = 0.005) were independent predictors of BCR.

Conclusions: An increased % cribriform value was associated with BCR in patients with GS 4 + 4 prostate cancer following RARP.

Keywords: Gleason pattern 4; biochemical recurrence; cribriform morphology area ratio; prostate cancer; robot-assisted radical prostatectomy.

MeSH terms

Humans
Male
Neoplasm Grading
Neoplasm Recurrence, Local / pathology
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms* / pathology
Robotics*

Substances

Prostate-Specific Antigen