未被检测到的筛状腺癌和导管内前列腺癌在活检中的相关不良预后

Undetected Cribriform and Intraductal Prostate Cancer at biopsy is associated with adverse outcomes

PROSTATE CANCER AND PROSTATIC DISEASES

影响因子:5.8

发表日期:2025 Mar

作者: Rui M Bernardino, Leyi B Yin, Katherine Lajkosz, Jessica G Cockburn, Marian Wettstein, Rashid K Sayyid, Rui Henrique, Luís Campos Pinheiro, Theodorus van der Kwast, Neil E Fleshner

DOI: 10.1038/s41391-024-00910-3

摘要

导管内癌（IDC）和筛状图案（Crib）是前列腺癌中逐渐被认可的独立预后指标，无论是在活检样本还是根治性前列腺切除（RP）标本中。我们的研究目的是评估这些特征在假阴性活检中的影响以及其对肿瘤学预后的影响。在2015年1月至2022年12月期间接受RP的患者中，纳入本研究。通过多变量Cox比例风险模型分析生化复发的预测因素。在接受RP的836名患者中，233名（27.9%）在活检中表现为Crib，125名（15.0%）表现为IDC，其中71名（8.5%）同时具有IDC和Crib。关于活检时IDC/Crib的状态，217名（26%）存在假阴性，332名（39.7%）为真阴性，256名（30.6%）为真阳性，24名（3.7%）为假阳性。比较假阴性、假阳性、真阴性和真阳性活检在IDC/Crib方面的情况，发现假阴性活检的患者比真阴性患者出现晚期病理分期（≥pT3）的比例高出一倍，分别为56.8%对28.1%（p < 0.001）。多变量Cox分析显示，RP前的血清PSA对数（HR 2.07，95% CI 1.53-2.82；p < 0.001）、活检阳性核心比例较高（≥33%）（HR 1.68，95% CI 1.07-2.63；p = 0.024）以及IDC/Crib的假阴性（HR 2.14，95% CI 1.41-3.25；p < 0.001）均与生化复发风险显著增加相关。假阴性活检相比真阴性，更独立地与更高的BCR风险和晚期病理分期相关。

Abstract

Intraductal carcinoma (IDC) and cribriform pattern (Crib) of prostate cancer are increasingly recognized as independent prognosticators of poor outcome, both in prostate biopsies and radical prostatectomy (RP) specimens.The aim of our project is to assess the impact of false negative biopsies for these two characteristics on oncological outcomes.Patients who underwent RP between January 2015 and December 2022 were included in the study. Predictors of Biochemical Failure were examined using a multivariate Cox proportional hazards model.Among the 836 patients who underwent RP, 233 (27.9%) had Crib, and 125 (15.0%) had IDC on prostate biopsy, with 71 (8.5%) patients having both IDC and Crib. Concerning IDC/Crib status at biopsy, 217 (26%) patients had a false-negative biopsy, 332 (39.7%) had a true-negative biopsy, 256 (30.6%) showed a true-positive biopsy, and 24 (3.7%) exhibited a false-positive biopsy, with respect to either pattern. When comparing false-negative, false-positive, true-negative and true-positive biopsies for IDC/Crib, we found that patients with a false-negative biopsy for IDC/Crib versus those with a true-negative biopsy for IDC/Crib disclosed a rate of advanced pathological stage (≥pT3) which was twice that of patients with a true-negative biopsy for IDC/Crib: 56.8% versus 28.1%, respectively (p < 0.001). On multivariate Cox analysis, log PSA before RP (hazard ratio [HR] 2.07, 95% CI 1.53-2.82; p < 0.001), a higher percentage of positive cores at biopsy ( ≥ 33%) (HR 1.68, 95% CI 1.07-2.63; p = 0.024), and false negative biopsy for IDC/Crib (HR 2.14, 95% CI 1.41-3.25; p < 0.001), were each significantly associated with an increased risk of BCR.A false-negative biopsy for IDC/Crib is independently associated with higher risk of BCR and advanced pathological stage compared to a true negative biopsy.