The relationship of morphological tumor heterogeneity with lymph node metastasis in prostatic adenocarcinomas

Year 2023, Volume: 2 Issue: 3, 122 - 128, 25.09.2023

Sümeyye Ekmekci , Esra Canan Kelten Talu , Erdem Kısa , Ülkü Küçük

https://doi.org/10.57221/izmirtip.1289254

Abstract

Aim:The aim of our study isto investigate effect of prostatic carcinoma histopathological subtypes to the lymph node metastasis (LNM).
Materials- Methods:A total of 102 patients who underwent radical prostatectomy (RP) and pelvic lymph node disection were included in the study. Tumor grades, accompanying intraductal carcinoma (IDC-P)/ductal adenocarcinoma (PDA), LNM, extraprostatic extension (EPE) and seminal vesicle invasion (SVI) were recorded.
Results: While 76 of the tumors had pure acinar adenocarcinoma (AC) histology, IDC-P accompanied AC in 17 and PDA in 9 cases. The tumors accompanying IDC-P and PDA were all stage 3 and stage 4. In pure AC cases, a statistically significant relationship was observed between the increased tumor grade and advanced stage. The positive relationship was determined between high GG with LNM, SVI and EPE in pure AC cases. LNM was observed in 11 of 17 cases accompanied by IDC-P, SVI in 10, and EPE in 16 cases. All 9 cases with PDA accompanying the tumor had EPE, 8 of the cases had LNM and SVI. A statistically significant relationship was observed between presence of LNM, SVI, EPE and accompanying IDC-P/PDA. When high graded tumors were examined, similar to results mentioned above, it was observed that IDC-P/PDA has accompanied AC thus, the risk of having LNM increased.
Conclusion: In our study, it was noted that the presence of IDC-P/PDA accompanying the tumor significantly increased the risk of LNM, and it was thought that considering both these data in LNM risk analysis may provide a more accurate approach in treatment planning.

Prostat Adenokarsinomlarında Morfolojik Tümör Heterojenitesinin Lenf Nodu Metastazı ile İlişkisi

Abstract

Amaç: Çalışmamızın amacı prostat karsinomu histopatolojik alt tiplerinin lenf nodu metastazına (LNM) etkisini araştırmaktır.
Gereç-Yöntem:Çalışmaya radikal prostatektomi (RP) ve pelvik lenf nodu diseksiyonu uygulanan toplam 102 hasta dahil edildi.Tümör dereceleri, eşlik eden intraduktal karsinom (IDC-P)/duktal adenokarsinom (PDA), LNM, ekstraprostatik yayılım (EPE) ve seminal vezikül invazyonu (SVI) kaydedildi.
Bulgular: Tümörlerin 76'sında pür asiner adenokarsinom (AK) histolojisi bulunurken, 17'sinde IDC-P, 9'unda PDA'ya AK eşlik etti.IDC-P ve PDA'ya eşlik eden tümörlerin tümü evre 3 ve evre 4 idi.Saf AK vakalarında, artmış tümör derecesi ile ileri evre arasında istatistiksel olarak anlamlı bir ilişki gözlendi.Saf AK olgularında yüksek GG ile LNM, SVI ve EPE arasında pozitif ilişki saptandı.17 olgunun 11'inde LNM, 10'unda IDC-P, SVI ve 16'sında EPE izlendi.Tümöre eşlik eden PDA'lı 9 olgunun hepsinde EPE, 8 olguda LNM ve SVI vardı.LNM, SVI, EPE varlığı ile eşlik eden IDC-P/PDA arasında istatistiksel olarak anlamlı bir ilişki gözlendi. Yüksek dereceli tümörler incelendiğinde, yukarıda belirtilen sonuçlara benzer şekilde, IDC-P/PDA'nın AC'ye eşlik ettiği ve bu nedenle LNM olma riskinin arttığı görülmüştür.
Sonuç: Çalışmamızda tümöre eşlik eden IDC-P/PDA varlığının LNM riskini anlamlı olarak arttırdığı belirtilmiş ve LNM risk analizinde bu iki verinin de dikkate alınmasının tedavi planlamasında daha doğru bir yaklaşım sağlayabileceği düşünülmüştür.

Keywords

Prostat, adenokarsinom, lenf nodu, metastaz

References

• References 1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA: A Cancer Journal of Clinicians. 2018; 68:7–30.
• 2. Fossati N, Willemse PM, Van den Broeck T, Van den Bergh RCN, Yuan CY, Briers E, et al. The benefits and harms of different extents of lymph node dissection during radical prostatectomy for prostate cancer: a systematic review. European Urology. 2017;72:84-109.
• 3. Moch H, Humphrey PA, Ulbright TM, Reuter VE, editors. WHO classification of tumours of the urinary system and male genital organs. Lyon, France, IARC; 2016.
• 4. Kimura K, Tsuzuki T, Kato M, Saito AM, Sassa N, Ishida R et al. Prognostic value of intraductalcarcinoma of the prostate in radical prostatectomy specimens. Prostate 2014;74:680–87.
• 5. Knipper S, Preisser F, MazzoneE. Contemporary comparison of clinicopathologic characteristics and survival outcomes of prostate ductal carcinoma and acinar adenocarcinoma: a population-based study. Clinical Genitourinary Cancer. 2019;17:231-37. Ekmekci et al. No grants or support resources were used. The writers do not have any conflicts of interest. All authors declared their contribution to the study at all stages. All authors took part in the study design and approve the final version of the manuscript. 128
• 6.Gordetsky J, Epstein J. Grading of prostatic adenocarcinoma: current state and prognostic implications. Diagnostic Pathology. 2016;11:25.
• 7.Humphrey PA. Histological variants of prostatic carcinoma and their significance. Histopathology. 2012;60:59-74.
• 8.Epstein JI. Prostatic ductal adenocarcinoma: a mini review. Medical Principal Practice 2010;19:82‐85.
• 9.Wu T, Zhao J, Liu Z, Shen P, Zhang M, Sun G et al. Does ductal adenocarcinoma of the prostate (DA) have any prognostic impact on patients with de novo metastatic prostate cancer? Prostate. 2019;79:1673-82.
• 10.Meeks JJ, Zhao LC, Cashy J, Kundu S. Incidence and outcomes of ductal carcinoma of the prostate in the USA: analysis of data from the surveillance, epidemiology, and end results program. BJU International. 2011;109:831-34.
• 11.Seipel AH, Delahunt B, Samarattunga H, Egevad L. Ductal adenocarcinoma of the prostate: histogenesis, biology and clinicopathological features. Pathology. 2016;48:398-405.
• 12.Amin A, Epstein JI. Pathologic Stage of prostatic ductal adenocarcinoma at radical prostatectomy: effect of percentage of the ductal component and associated grade of acinar adenocarcinoma. The American Journal of Surgical Pathololgy. 2011;35:615-19.
• 13.Seipel AH, Wiklund F, Wiklund PN, Egevad L. Histopathological features of ductal adenocarcinoma of the prostate in 1,051 radical prostatectomy specimens. Virchows Archiv. 2013;462:429-36.
• 14.Lakymenko OA, Lugo I, Kwon D, Zhao W, Hayee A, Punnen S et al. Prostatic ductal adenocarcinoma controlled for cancer grade and tumor volume does not have an independent effect on adverse radical prostatectomy outcomes compared to usual acinar prostatic adenocarcinoma. Urology. 2020;137:108-114.
• 15.Kryvenko ON, Lakymenko OA, Guido LL, Bhattu AS, Merhe A, Mouzannar A, et al. Prostatic ductal adenocarcinoma controlled for tumor grade, stage and margin status does not independently influence the likelihood of biochemical recurrence in localizde prostate cancer after radical prostatectomy. Arch Pathol Lab Med. 2021;8:1-7.
• 16.Khani F, Epstein JI. Prostate biopsy specimens with Gleason 3+3=6 and intraductal carcinoma: radical prostatectomy findings and clinical outcomes. Am J Surg Pathol. 2015;39:1383-89.
• 17.Montironi R, Zhou M, Magi-Galluzzi C, Epstein JI. Features and prognostic significance of intraductal carcinoma of the prostate. European Urological Oncology. 2018;1:21-28.
• 18.Miura N, Mori K, Mostafaei H, Quhal F, Motlagh S, Pradere B, et al. The prognostic impact of intraductal carcinoma of the prostate: a systemic review and meta-analysis. J Urol. 2020;204:909-17.
• 19.Cheng L, Zincke H, Blute ML, Bergstralh EJ, Scherer B,Bostwick DG. Risk of prostate carcinoma death in patients with lymph node metastasis. Cancer. 2001;91:66–73.
• 20.Downes MR, Xu B, van der Kwast TH. Cribriform architecture prostatic adenocarcinoma in needle biopsies isastrong independent predictor for lymph node metastases in radical prostatectomy. Eur J Cancer. . 2021;148:432-39
• 21. Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N et al. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: The essential importance of percentage of positive cores. European Urology. 2012;61:480-87.
• 22.Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, Santis MD et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1. Screening, diagnosis, and local treatment with curative intent. European Urology. 2017;71:618-29.
• 23.Kryvenko ON, Gupta NS, Virani N, Schultz D, Gomez J, Amin A et al. Gleason score 7 adenocarcinoma of the prostate with lymph node metastases analysis of 184 radical prostatectomy specimens. Arch Pathol Lab Med. 2013;137:610-17.