Large and small cribriform architecture have similar adverse clinical outcome on prostate cancer biopsies

Aims: Invasive cribriform and intraductal carcinoma (IDC) are associated with adverse outcome in prostate cancer patients, with the large cribriform pattern having the worst outcome in radical prostatectomies. Our objective was to determine the impact of the large and small cribriform patterns in prostate cancer biopsies. Methods and results: Pathological revision was carried out on biopsies of 1887 patients from the European Randomised Study of Screening for Prostate Cancer. The large cribriform pattern was defined as having at least twice the size of adjacent benign glands. The median follow-up time was 13.4 years. Hazard ratios for metastasis-free survival (MFS) and disease-specific survival (DSS) were calculated using Cox proportional hazards regression. Any cribriform pattern was found in 280 of 1887 men: 1.1% IDC in grade group (GG) 1, 18.2% in GG2, 57.1% in GG3, 55.4% in GG4 and 59.3% in GG5; the large cribriform pattern was present in 0, 0.5, 9.8, 18.1 and 17.3%, respectively. In multivariable analyses, small and large cribriform patterns were both (P &lt; 0.005) associated with worse MFS [small: hazard ratio (HR) = 3.04, 95% confidence interval (CI) = 1.93–4.78; large: HR = 3.17, 95% CI = 1.68–5.99] and DSS (small: HR = 4.07, 95% CI = 2.51–6.62; large: HR = 4.13, 95% CI = 2.14–7.98). Patients with the large cribriform pattern did not have worse MFS (P = 0.77) or DSS (P = 0.96) than those with the small cribriform pattern. Conclusions: Both small and large cribriform patterns are associated with worse MFS and DSS in prostate cancer biopsies. Patients with the large cribriform pattern on biopsy have a similar adverse outcome as those with the small cribriform pattern.</p

Changes in the stage and surgical management of renal tumours during 1995-2005: an analysis of the Dutch national histopathology registry

OBJECTIVE: To evaluate changes in the pathological characteristics, stage of primary renal tumours and their surgical management in the Netherlands during the period 1995-2005. METHODS: Extracts from the records of all patients who had surgery for primary renal tumours in the Netherlands during the period 1995-2005 were reviewed. Data were collected from PALGA, the nationwide network and archive of histocytopathology. The 2002 Tumour-Node-Metastasis and the three-tier Fuhrman grade were used for staging and grading. RESULTS: In all there were 12 471 operations for primary renal masses during the study period. The incidence of surgically removed renal cancers increased from 6.2 in 1995 to 7.5 cases per 100 000 inhabitants (P = 0.005) in 2005. The mean (sd, median) age of the patients was 63.3 (11.9, 65.0) years, with a male-to-female ratio of 3:2. The mean (sd) tumour size of malignant tumours decreased from 7.3 (3.6) to 6.9 (3.7) cm (P = 0.301). The percentage of benign removed tumours remained relatively stable (P = 0.056), with a mean of 5.4% of all resected tumours. There was an increase of grade 1 tumours; the incidence of T1 tumours increased from 36.6% to 44.2%, and advanced tumours decreased from 46.4% to 33.7%, respectively. The percentage of nephron-sparing surgery increased from 3.5% in 1995 to 10.1% (P = 0.003) in 2005, mainly in the T1a tumours. CONCLUSIONS: During the last decade there was an increase in the incidence of surgically treated renal tumours in the Netherlands. Tumours with favourable histopathological characteristics, low stage and grade, accounted for most of this increase. The percentage of surgically removed benign tumours remained stable. The use of nephron-sparing surgery increased during the last decade, especially in T1a tumour

De klinische relevantie van cribriforme en intraductale prostaatkanker in diagnostische naaldbiopten

Cribriform and intraductal prostate cancer are both associated with an adverse outcome after radical prostatectomy. We included all patients with prostate cancer from the first screening round of the European Randomized Study of Screening for Prostate Cancer (ERSPC). All available slides were revised and scored for presence of cribriform and/or intraductal prostate cancer. Outcome measurements were biochemical recurrence and disease-specific survival. In total, 486 patients had Gleason score (GS) 6 (47%) and 545 GS ≥7 (53%). The disease-specific survival and biochemical-recurrence-free survival of CR/IDC−-GS3+4 patients did not differ significantly from those with GS 6, while patients with CR/IDC+-GS3+4-patients had a significant poorer outcome. Conclusion: The presence of cribriform and intraductal growth in prostate cancer, is a strong clinical prognostic marker with potential. The use of this variable in a clinical setting could contribute to reducing overtreatment of prostate cancer

A Decade of Surgically Removed Small Renal Masses in The Netherlands: Characteristics and Trends in Type of Surgery and Pathologic Reporting

Purpose: To assess nationwide the pathologic characteristics and trends in type of surgery and pathologic reporting in surgically managed renal tumors = T-3). Tumors <= 3.0 cm were more likely to be benign (P = 0.006) and of lower stage (P = <0.001) than tumors of 3.1 to 4 cm. PN was performed in 16.5% of the cases. Grade and subtype were reported in 55% of the cases. The rate of PNs performed increased during the decade. There was a trend in increased reporting of grade and subtype. Conclusions: A quarter of all the operated primary kidney tumors were <= 4 cm. Smaller tumors were more likely to be benign and of lower stage. A cutoff size regarding biologic aggressiveness can be settled at the 3 cm size. The PN rate increased along the decade. Grade and subtype reporting rates remained suboptimal, although a positive trend was note

De klinische relevantie van cribriforme en intraductale prostaatkanker in diagnostische naaldbiopten

Cribriform and intraductal prostate cancer are both associated with an adverse outcome after radical prostatectomy. We included all patients with prostate cancer from the first screening round of the European Randomized Study of Screening for Prostate Cancer (ERSPC). All available slides were revised and scored for presence of cribriform and/or intraductal prostate cancer. Outcome measurements were biochemical recurrence and disease-specific survival. In total, 486 patients had Gleason score (GS) 6 (47%) and 545 GS ≥7 (53%). The disease-specific survival and biochemical-recurrence-free survival of CR/IDC−-GS3+4 patients did not differ significantly from those with GS 6, while patients with CR/IDC+-GS3+4-patients had a significant poorer outcome. Conclusion: The presence of cribriform and intraductal growth in prostate cancer, is a strong clinical prognostic marker with potential. The use of this variable in a clinical setting could contribute to reducing overtreatment of prostate cancer