Cribriform architecture prostatic adenocarcinoma in needle biopsies is a strong independent predictor for lymph node metastases in radical prostatectomy

Abstract

Aim: Lymph node metastases (pN1) at prostatectomy are infrequent but impact prognosis. Traditional prostate nomograms assess age, serum prostatic-specific antigen (PSA), clinical stage, and biopsy parameters to inform decisions on pelvic lymph node dissection. The impact of intraductal carcinoma (IDC) and cribriform pattern 4 (CC) on nodal metastases has yet to be explored.

Methods: Five hundred forty three radical prostatectomy cases were reviewed for International Society of Urological Pathology (ISUP) grade, CC/IDC, T- and N-stage. Two hundred seventy five cases had matched biopsies with age, serum PSA, CC/IDC and ISUP grade recorded. The association of CC/IDC with pN1 in both prostatectomy and biopsy settings was assessed using Fisher's exact test, as well as univariable (UVA) and multivariable (MVA) logistic regression.

Results: In 543 men in whom a prostatectomy was performed, a nodal dissection was also available in 340 (63%), and 37 (10.9%) of them had pN1 disease. ISUP grade, stage and CC/IDC were significantly associated with pN1 (p < 0.001). UVA regression showed grade (p < 0.001, odds ratio [OR]: 5.85), CC/IDC (p = 0.003, OR: 14.06) and T stage (p = 0.004, OR: 61.94) associated with pN1 as did MVA regression: grade (p = 0.010, OR: 2.81), CC/IDC (p = 0.015, OR: 5.12) and T stage (p = 0.016, OR: 30.38). In 275 patients with matched biopsies, a nodal dissection was performed in 197 (71.6%) and 20 (10.2%) patients had pN1 disease. On UVA regression, grade (p < 0.001, OR: 6.33), CC/IDC (p = 0.013, OR: 3.28), serum PSA (p = 0.001, OR: 1.08) and age (p = 0.047, OR: 1.07) were significant for pN1 at prostatectomy. All parameters including specifically grade (p = 0.007, OR: 5.35) and CC/IDC (p = 0.018, OR: 4.42) on biopsies predicted for pN1 by multivariate analysis.

Conclusion: CC/IDC in prostatectomy and biopsy significantly associates with pN1. Incorporation of CC/IDC status into preoperative nomograms may optimize patient selection for pelvic nodal dissection.

Keywords: Cribriform; Intraductal; Lymph nodes; Metastases; Nomogram; Prognosis; Prostate.