Effect of Gleason scores of lymph node metastases on prognosis of patients with prostate cancer

Abstract

The long-term mortality risk from prostate cancer increases in lymph node (LN) positive patients. This study was done to assess the effect of lymph node Gleason score (LNGS) on prognosis in patients with LN-positive prostate cancer. Among the 1,415 patients who received pelvic lymph node dissection (PLND), 117 (8.4%) patients had a positive LN. The PGS of the prostate specimens and the LNGS of the positive LNs were assessed by uropathologists. The median age of patients at surgery was 67 years (interquartile range [IQR], 62-71 years) and the median follow-up duration was 44.3 months (IQR, 27.0-78.5 months). Pathologic Gleason scores (PGS) of 6-9 included one (0.9%), 53 (49.5%), 22 (20.6%), and 31 (29.0%) patients. The median total number of retrieved LNs was 9.0 (IQR, 5.3-12.8). The median number of positive LNs was one (IQR, 1-2). Cancer architecture with a Gleason pattern and score were observed in LNs as in ordinary prostate specimens. LNGS 6-9 included nine (8.1%), 57 (51.4%), 31 (27.9%), and 14 (12.6%) patients. The speaman's analysis showed the meaningful correlation between PGS and LNGS (P = 0.249, P = 0.011). The univariate analysis showed that the number of positive LNs and LNGS were significantly associated with prostate cancer-specific survival (P = 0.028; P = 0.005). The same architecture that is seen in the prostate was seen in positive LNs, and LNGS may be a significant prognostic factor in patients with LN-positive prostate cancer.

Keywords: Gleason score; lymph node metastasis; prognosis; prostate cancer; radical prostatectomy.

Figure 1

Metastatic prostatic adenocarcinoma in the lymph node showing cribriform gland formation (Gleason score 8 (4+4)). (A) A low power scan. Left lower; positive lymph node, right upper; normal lymph node. (B) Higher magnification of (A) (Original magnification in (A), ×1.25 and (B) ×200).

Figure 2

Examinations of metastatic carcinoma. A. Metastatic adenocarcinoma in lymph nodes showing Gleason score 6 (double sum of pattern 3). Well formed glands are observed in lymphoid tissue. (Original magnification = ×200). B. Metastatic adenocarcinoma in lymph nodes showing Gleason score 7 (pattern 4 and pattern 3). Both discrete gland formation and ill defined glandular unit are observed in lymphoid tissue. (Original magnification = ×200). C. Metastatic adenocarcinoma in lymph nodes showing Gleason score 8 (double sum of pattern 4). The large cribriform glands are observed in lymphoid tissue. (Original magnification = ×200). D. Metastatic adenocarcinoma in lymph nodes showing Gleason score 9 (pattern 4 and pattern 5). Poorly differentiated gladular cells with solid proliferation or single cell infiltration is observed in lymphoid tissue. (Original magnification = ×200).