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Addition of cribriform pattern 4 and intraductal prostatic carcinoma into the CAPRA-S tool improves post-radical prostatectomy patient stratification in a multi-institutional cohort
  1. Ngoc-Nhu Jennifer Nguyen1,
  2. Kristen Liu2,
  3. Katherine Lajkosz3,
  4. Kenneth A Iczkowski2,
  5. Theodorus H van der Kwast1,4,
  6. Michelle R Downes1,5
  1. 1Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  3. 3Department of Biostatistics, University Health Network, Toronto, Ontario, Canada
  4. 4Department of Pathology, University Health Network, Toronto, Ontario, Canada
  5. 5Department of Anatomic Pathology, Precision Diagnostics & Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Michelle R Downes, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada; michelle.downes{at}sunnybrook.ca

Abstract

Aims Pre-surgical risk classification tools for prostate cancer have shown better patient stratification with the addition of cribriform pattern 4 (CC) and intraductal prostatic carcinoma (IDC) identified in biopsies. Here, we analyse the additional prognostic impact of CC/IDC observed in prostatectomies using Cancer of Prostate Risk Assessment post-surgical (CAPRA-S) stratification.

Methods A retrospective cohort of treatment-naïve radical prostatectomy specimens from three North American academic institutions (2010–2018) was assessed for the presence of CC/IDC. Patients were classified, after calculating the CAPRA-S scores, into low-risk (0–2), intermediate-risk (3–5) and high-risk (6–12) groups. Kaplan-Meier curves were created to estimate biochemical recurrence (BCR)-free survival. Prognostic performance was examined using Harrell’s concordance index, and the effects of CC/IDC within each risk group were evaluated using the Cox proportional hazards models.

Results Our cohort included 825 prostatectomies (grade group (GG)1, n=94; GG2, n=475; GG3, n=185; GG4, n=13; GG5, n=58). CC/IDC was present in 341 (41%) prostatectomies. With a median follow-up of 4.2 years (range 2.9–6.4), 166 (20%) patients experienced BCR. The CAPRA-S low-risk, intermediate-risk and high-risk groups comprised 357 (43%), 328 (40%) and 140 (17%) patients, and discriminated for BCR-free survival (p<0.0001). For CAPRA-S scores 3–5, the addition of CC/IDC status improved stratification for BCR (HR 2.27, 95% CI 1.41 to 3.66, p<0.001) and improved the overall c-index (0.689 vs 0.667, analysis of variance p<0.001).

Conclusion The addition of CC/IDC into the CAPRA-S classification significantly improved post-radical prostatectomy patient stratification for BCR among the intermediate-risk group (CAPRA-S scores 3–5). The reporting of CC and IDC should be included in future prostate cancer stratification tools for improved outcome prediction.

  • PROSTATE
  • Urologic Neoplasms
  • Morphological and Microscopic Findings

Data availability statement

Data are available upon reasonable request. Data used and/or analysed in the present study are available from the corresponding author on reasonable request.

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Data availability statement

Data are available upon reasonable request. Data used and/or analysed in the present study are available from the corresponding author on reasonable request.

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Footnotes

  • Handling editor Murali Varma.

  • Presented at This work was presented in part, as an abstract, at the 2023 European Congress of Pathology, 13 September 2023, Ireland, Dublin.

  • Contributors N-NJN interpreted the data and drafted the manuscript. KAI gathered and interpreted the data, and revised the manuscript. KLi gathered the data. KLa conducted the statistical analyses. THvdK gathered and interpreted the data, and revised the manuscript. MRD designed the study, gathered and interpreted the data, and revised the manuscript. MRD is the guarantor. All authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.