In:
The Prostate, Wiley, Vol. 81, No. 12 ( 2021-09), p. 866-873
Abstract:
Increasing percentages of Gleason pattern 4 (GP4%) in radical prostatectomy (RP) correlate with an increased likelihood of nonorgan‐confined disease and earlier biochemical recurrence (BCR). However, there are no detailed RP studies assessing the impact of GP4% and corresponding tumor volume (TV) on extraprostatic extension (EPE), seminal vesicle (SV) invasion (SV+), and positive surgical margin (SM) status (SM+). Methods In 1301 consecutive RPs, we analyzed each tumor nodule (TN) for TV, Grade Group (GG), presence of focal versus nonfocal EPE, SV+ , and SM+. Using GG1 (GP4% = 0) TNs as a reference, we recorded GP4% for all GG2 or GG3 TNs. We performed a multivariable analysis (MVA) using a mixed effects logistic regression that tested significant variables for risk of EPE, SV+, and SM+, as well as a multinomial logistic regression model that tested significant variables for risks of nonorgan‐confined disease (pT2+, pT3a, and pT3b) versus organ‐confined disease (pT2). Results We identified 3231 discrete TNs ranging from 1 to 7 (median: 2.5) per RP. These included GG1 ( n = 2115), GG2 ( n = 818), GG3 ( n = 274), and GG4 ( n = 24) TNs. Increasing GP4% weakly paralleled increasing TV (tau = 0.07, p 〈 .001). In MVA, increasing GP4% and TV predicted a greater likelihood of EPE (odds ratio [OR]: 1.03 and 4.41), SV+ (OR: 1.03 and 3.83), and SM+ (1.01, p = .01 and 2.83), all p 〈 .001. Our multinomial logistic regression model demonstrated an association between GP4% and the risk of EPE (i.e., pT3a and pT3b disease), as well as an association between TV and risk of upstaging (all p 〈 .001). Conclusions Both GP4% and TV are independent predictors of adverse pathological stage and margin status at RP. However, the risks for adverse outcomes associated with GP4% are marginal, while those for TV are strong. The prognostic significance of GP4% on BCR‐free survival has not been studied controlling for TV and other adverse RP findings. Whether adverse pathological stage and margin status associated with larger TV could decrease BCR‐free survival to a greater extent than increasing RP GP4% remains to be studied.
Type of Medium:
Online Resource
ISSN:
0270-4137
,
1097-0045
Language:
English
Publisher:
Wiley
Publication Date:
2021
detail.hit.zdb_id:
1494709-2
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