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Li J, Cohen RJ. Impact of Autonomic Nerve Invasion on Biochemical Recurrence for Intermediate Risk T3a Prostate Cancer With Negative Surgical Margins After Radical Prostatectomy. Urology 2024:S0090-4295(24)00643-5. [PMID: 39127159 DOI: 10.1016/j.urology.2024.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/23/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To assess the impact of autonomic nerve invasion (ANI) on subsequent biochemical recurrence (BCR) or early adjuvant therapy in the patients with extraprostatic spread (EPS) and negative margins after radical prostatectomy (RP). METHODS A total of 218 men with EPS (T3a) and negative margins were identified who underwent RP in Western Australia from January 2014 to December 2016. The t-test, Pearson chi-square test and Kaplan-Meier method with the log-rank test were used to evaluate differences between the ANI and non-ANI. Univariate and multivariable Cox proportional hazard regression models were applied to assess the impact of these parameters on BCR or early treatment and a model calibration was performed by the internal validation method. RESULTS ANI group had a significantly higher incidence in BCR or early adjuvant therapy compared to non-ANI group (hazard ratio 1.94, 95% CI 1.12-3.37, P = .02). Further analyses showed that ANI was significantly associated with BCR or early adjuvant therapy (hazard ratio 3.03, 95% CI 1.28-7.15, P = .01) in intermediate-risk cases (Gleason sum (GS)= 7, ie, International Society of Urological Pathology (ISUP) groups 2/3) but not in high-risk group (GS≥8/ISUP 4/5). CONCLUSION For the patients with EPS (T3a) and negative margins, ANI significantly and independently increases the chances of BCR or early adjuvant therapy for intermediate-risk disease (GS=7/ISUP 2/3) but it is not an independent predictor for high-risk disease (GS≥8/ISUP 4/5). This provides a simple cost-effective method to further stratify margin negative intermediate-risk T3a prostate cancer.
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Affiliation(s)
- Jian Li
- Uropath Pty Ltd, Perth, Western Australia, Australia
| | - Ronald J Cohen
- Uropath Pty Ltd, Perth, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia.
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Bell PD, Teramoto Y, Gurung PMS, Numbere N, Yang Z, Miyamoto H. The Clinical Significance of Perineural Invasion by Prostate Cancer on Needle Core Biopsy. Arch Pathol Lab Med 2022; 146:1252-1257. [PMID: 35020791 DOI: 10.5858/arpa.2021-0248-oa] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 12/24/2022]
Abstract
CONTEXT.— Perineural invasion (PNI) by prostate cancer has been associated with adverse pathology, including extraprostatic extension. However, the significance of PNI quantification on prostate biopsy (PBx) remains unclear. OBJECTIVE.— To compare radical prostatectomy (RP) findings and long-term outcomes in patients whose PBx had exhibited PNI. DESIGN.— We assessed 497 consecutive patients undergoing sextant (6-site/≥12-core) PBx showing conventional adenocarcinoma followed by RP. RESULTS.— PNI was found in 1 (n = 290)/2 (n = 132)/3 (n = 47)/4 (n = 19)/5 (n = 5)/6 (n = 4) of the sites/regions of PBx. Compared with a single PNI site, multiple PNIs were significantly associated with higher preoperative prostate-specific antigen, higher Grade Group (GG) on PBx or RP, higher pT or pN category, positive surgical margin, and larger estimated tumor volume. When compared in subgroups of patients based on PBx GG, significant differences in RP GG (GG1-3), pT (GG1-2/GG1-3/GG2/GG3), surgical margin status (GG1-3/GG3/GG5), or tumor volume (GG1-2/GG1-3/GG2/GG3) between 1 versus multiple PNIs were observed. Moreover, there were significant differences in prostate-specific antigen (PNI sites: 1-2 versus 3-6/1-3 versus 4-6/1-4 versus 5-6), RP GG (1-3 versus 4-6/1-4 versus 5-6), pT (1-2 versus 3-6/1-3 versus 4-6), pN (1-3 versus 4-6), or tumor volume (1-2 versus 3-6/1-4 versus 5-6). Outcome analysis revealed significantly higher risks of disease progression in the entire cohort or PBx GG1-2/GG1-3/GG2/GG3/GG5 cases showing 2 to 6 PNIs, compared with respective controls with 1-site PNI. In multivariate analysis, multisite PNI was an independent predictor for progression (hazard ratio = 1.556, P = .03). CONCLUSIONS.— Multiple sites of PNI on PBx were associated with worse histopathologic features in RP specimens and poorer prognosis. PNI may thus need to be specified, if present, in every sextant site on PBx, especially those showing GG1-3 cancer.
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Affiliation(s)
- Phoenix D Bell
- From the Department of Pathology & Laboratory Medicine (Bell, Teramoto, Numbere, Yang, Miyamoto), University of Rochester Medical Center, Rochester, New York
| | - Yuki Teramoto
- From the Department of Pathology & Laboratory Medicine (Bell, Teramoto, Numbere, Yang, Miyamoto), University of Rochester Medical Center, Rochester, New York.,James P. Wilmot Cancer Institute (Teramoto, Miyamoto), University of Rochester Medical Center, Rochester, New York
| | - Pratik M S Gurung
- The Department of Urology (Gurung, Miyamoto), University of Rochester Medical Center, Rochester, New York
| | - Numbereye Numbere
- From the Department of Pathology & Laboratory Medicine (Bell, Teramoto, Numbere, Yang, Miyamoto), University of Rochester Medical Center, Rochester, New York
| | - Zhiming Yang
- From the Department of Pathology & Laboratory Medicine (Bell, Teramoto, Numbere, Yang, Miyamoto), University of Rochester Medical Center, Rochester, New York
| | - Hiroshi Miyamoto
- From the Department of Pathology & Laboratory Medicine (Bell, Teramoto, Numbere, Yang, Miyamoto), University of Rochester Medical Center, Rochester, New York.,James P. Wilmot Cancer Institute (Teramoto, Miyamoto), University of Rochester Medical Center, Rochester, New York.,The Department of Urology (Gurung, Miyamoto), University of Rochester Medical Center, Rochester, New York
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Wu S, Xie L, Lin SX, Wirth GJ, Lu M, Zhang Y, Blute ML, Dahl DM, Wu CL. Quantification of perineural invasion focus after radical prostatectomy could improve predictive power of recurrence. Hum Pathol 2020; 104:96-104. [PMID: 32673683 DOI: 10.1016/j.humpath.2020.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 01/04/2023]
Abstract
Perineural invasion (PNI) after radical prostatectomy (RP) is a common feature of prostate cancer (PCa) and has been associated with unfavorable tumor characteristics. However, its prognostic relevance is controversial. In this study, we evaluated the impact of both PNI status (PNI+ versus PNI-) and quantified number of PNI focus on the long-term prognosis of biochemical recurrence (BCR) after RP. After reevaluating PNI of a total of 721 patients with localized PCa who underwent RP at our institution between 2000 and 2002, we examined associations between PNI status or PNI focus number and clinicopathological factors including tumor stage, Gleason score, margin status, tumor location, preoperative prostate specific antigen, age, prostate weight as well as BCR outcome. PNI was present in 530 of 721 cases (73.5%) of the RP specimens and was associated with more aggressive disease. BCR occurred in 19.4% of all patients within a median follow-up period of 8.5 years. PNI+ status was associated with poor BCR prognosis in univariate analysis but lost in multivariate analysis. Based on the number of PNI focus, PNI was further divided into 2 distinct group: PNI+ a (≤3) and PNI+ b (>3). In a multivariate Cox regression model, PNI+ b (>3) was identified as an independent BCR prognostic factor. Quantification of PNI focus number beside the dichotomized status recording will not only provide more detailed information but also be a novel prognostic indicator for risk stratification. Further external validation will be needed for an optimal cut-off value of the PNI focus number. Our findings will help further research on the relevance of PNI in the pretreatment setting and support ongoing efforts to understand its role of cancer progression.
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Affiliation(s)
- Shulin Wu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Ling Xie
- Department of Pathology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Sharron X Lin
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Gregory J Wirth
- Division of Urology, Department of Surgery, Geneva University Hospital, Geneva, 1205, Switzerland
| | - Min Lu
- Department of Pathology, Peking University Third Hospital, Peking University Health Science Center, Beijing, 100191, China
| | - Yifen Zhang
- Department of Pathology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Michael L Blute
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Douglas M Dahl
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
| | - Chin-Lee Wu
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
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Wei PY, Li WY, Tai SK. Discrete Perineural Invasion Focus Number in Quantification for T1-T2 Oral Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2018; 160:635-641. [DOI: 10.1177/0194599818808510] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective Perineural invasion (PNI) has been an established poor prognostic feature for T1-T2 oral squamous cell carcinoma (OSCC). Different presentations and amounts of PNI are commonly observed, but PNI is currently recorded as being present or absent. This study asked whether the quantification of PNI provides additional information for early OSCC. Study Design Retrospective cohort study. Setting Tertiary referral medical center. Subjects and Methods Pathologic reevaluations were performed for 314 patients with T1-T2 OSCC who underwent curative surgery from June 2001 to August 2009. A novel parameter, PNI focus number, was defined for PNI quantification. With 5 PNI foci as the cutoff, patients were categorized into 3 groups: no PNI (0 PNI foci), low PNI (PNI foci, 1-5), and high PNI (PNI foci >5). Rate of cervical lymph node metastasis (LN+), 5-year disease-specific survival (DSS), and 5-year overall survival (OS) were analyzed among these groups. Results PNI focus number independently predicted for LN+, poor DSS, and poor OS in multivariate analysis after controlling for T classification, lymphovascular invasion, differentiation, margin, and tumor thickness. The 5-year DSS demonstrated a dose-dependent decrease among the 3 groups (no PNI, 88.6%; low PNI, 75.2%; high PNI, 33.8%; P < .001). Moreover, the 5-year DSS of the high PNI group was significantly worse than that of the low PNI group. Conclusion PNI focus number can be a novel parameter for PNI quantification in early OSCC. Although optimal quantification methods still require further investigation, this study offers clear clinical support for the nerve-tumor interaction hypothesis and advocates further mechanistic research for the exploration of PNI-related treatment concepts for OSCC.
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Affiliation(s)
- Pei-Yin Wei
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wing-Yin Li
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shyh-Kuan Tai
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Otolaryngology, National Yang-Ming University, Taipei, Taiwan
- Infection and Immunity Research Center, National Yang-Ming University, Taipei, Taiwan
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Muscarinic acetylcholine receptor 3 mediates vagus nerve-induced gastric cancer. Oncogenesis 2018; 7:88. [PMID: 30459304 PMCID: PMC6246593 DOI: 10.1038/s41389-018-0099-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/23/2018] [Accepted: 10/30/2018] [Indexed: 01/23/2023] Open
Abstract
Increasing evidence shows that the vagus nerve plays an important role in tumourigenesis. However, the effects and underlying mechanisms of the vagus nerve on gastric cancer (GC) development have not been established. In this study, we performed a unilateral truncal vagotomy at the subdiaphragmatic level in a mouse xenograft GC model to study the effects of the vagus nerve on GC development. Gene microarray analysis was used to explore the mechanism underlying this process. Significantly altered genes and pathways were analysed by Kyoto Encyclopaedia of Genes and Genomes analysis tool. We also detected muscarinic acetylcholine receptor 3 (M3) mRNA and protein levels by quantitative real-time polymerase chain reaction and immunohistochemical staining in mouse stomach tissue. To further confirm the functional role of M3, an in vivo M3 selective antagonist (darifenacin) assay was applied. Finally, we determined the M3 protein levels in human GC tissues and paired non-cancerous gastric tissues by immunohistochemical staining. We found that the surgical vagotomy inhibited the development of GC in an orthotopic xenograft mouse model. Further analysis showed that multiple signalling pathways participated in this process and that M3 was a key factor in these pathways. We established that the M3 mRNA and protein levels decreased in the vagotomy group relative to the sham group. We also demonstrated that the M3 antagonist suppressed the development of GC. Finally, we revealed that M3 protein level was up-regulated in human GC tissues. In conclusions, we revealed the functional role of M3 on mediating the effects of the vagus nerve on GC. Our study contributes to understanding the mechanism underlying the interaction between GC and the vagus nerve and may help to identify new therapeutic targets for GC.
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Tailored postoperative treatment of prostate cancer: final results of a phase I/II trial. Prostate Cancer Prostatic Dis 2018; 21:564-572. [PMID: 30038390 PMCID: PMC6283858 DOI: 10.1038/s41391-018-0064-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/27/2018] [Accepted: 05/24/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUD The European Organization for Research and Treatment of Cancer (EORTC) trial 22,911 reported 74% 5-year biochemical disease-free survival (bDFS) in patients with prostate carcinoma treated with radical prostatectomy (RP) followed by postoperative radiotherapy (RT). This study aimed to improve these outcomes by using a combined-intensified-modulated-adjuvant treatment, including RT and hormone therapy (HT) after RP. MATERIALS AND METHODS This phase I/II trial treatment was designed to improve 5-year bDFS from ~ 75 to 90%. Patients were consecutively enrolled using the following inclusion criteria: age < 80 years, histological diagnosis of prostate adenocarcinoma without known metastases, stage pT2-4N0-1, and Eastern Cooperative Oncology Group performance status of 0-2. All patients had at least one of these pathologic features: capsular perforation, positive surgical margins, seminal vesicle invasion, and pelvic lymph nodes involvement. A minimum dose of 64.8 Gy to the tumor bed was delivered in all patients. Depending on tumor characteristics at diagnosis, patients received a higher dose (70.2 Gy; 85.4%) and/or prophylactic pelvic lymph nodes irradiation (57.7%) and/or HT (69.1%). Biochemical relapse was defined as two consecutive rising prostate-specific antigen (PSA) values > 0.2 ng/ml. RESULTS A total of 123 patients were enrolled in the study and completed the scheduled treatment. Median preoperative and postoperative PSA were: 8.8 and 0.06 ng/mL, respectively. The percentages of patients with pathologically involved nodes and positive resection margins were: 14.6% and 58.5%, respectively. With a median follow-up of 67 months (range: 37-120 months), the actuarial 5-year bDFS, local control, metastasis-free survival, and overall survival (OS) were: 92.9%, 98.7%, 96.1%, and 95.1%, respectively. CONCLUSION A higher 5-year bDFS (92.9%) was recorded compared to studies based on standard adjuvant RT, even though patients with nodal disease and detectable postoperative PSA were enrolled. Clinical end points, as long-term disease-free survival and OS, will require further assessments. (ClinicalTrials.gov: NCT03169933).
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Reeves F, Hovens CM, Harewood L, Battye S, Peters JS, Costello AJ, Corcoran NM. Does perineural invasion in a radical prostatectomy specimen predict biochemical recurrence in men with prostate cancer? Can Urol Assoc J 2015; 9:E252-5. [PMID: 26029290 DOI: 10.5489/cuaj.2619] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The ability of perineural invasion (PNI) in radical prostatectomy (RP) specimens to predict biochemical recurrence (BCR) is unclear. This study investigates this controversial question in a large cohort. METHODS A retrospective analysis was undertaken of prospectively collected data from 1497 men who underwent RP (no neoadjuvant therapy) for clinically localized prostate cancer. The association of PNI at RP with other clinicopathological parameters was evaluated. The correlation of clinicopathological factors and BCR (defined as prostate-specific antigen [PSA] >0.2 ng/mL) was investigated with univariable and multivariable Cox regression analysis in 1159 men. RESULTS PNI-positive patients were significantly more likely to have a higher RP Gleason score, pT3 disease, positive surgical margins, and greater cancer volume (p < 0.0005). The presence of PNI significantly correlated with BCR on univariable (hazard ratio 2.30, 95% confidence interval 1.50-3.55, p < 0.0005), but not multivariable analysis (p = 0.602). On multivariable Cox regression analysis the only independent prognostic factors were preoperative PSA, RP Gleason score, pT-stage, and positive surgical margin status. These findings are limited by a relatively short follow-up time and retrospective study design. CONCLUSIONS PNI at RP is not an independent predictor of BCR. Therefore, routine reporting of PNI is not indicated. Future research should be targeted at the biology of PNI to increase the understanding of its role in prostate cancer progression.
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Affiliation(s)
- Fairleigh Reeves
- Department of Urology and Surgery, University of Melbourne, The Royal Melbourne Hospital, Australia
| | - Christopher M Hovens
- Department of Urology and Surgery, University of Melbourne, The Royal Melbourne Hospital, Australia; ; Australian Prostate Cancer Research Centre Epworth, Richmond, Australia
| | - Laurence Harewood
- Department of Urology and Surgery, University of Melbourne, The Royal Melbourne Hospital, Australia; ; Australian Prostate Cancer Research Centre Epworth, Richmond, Australia
| | | | - Justin S Peters
- Department of Urology and Surgery, University of Melbourne, The Royal Melbourne Hospital, Australia; ; Australian Prostate Cancer Research Centre Epworth, Richmond, Australia
| | - Anthony J Costello
- Department of Urology and Surgery, University of Melbourne, The Royal Melbourne Hospital, Australia; ; Australian Prostate Cancer Research Centre Epworth, Richmond, Australia
| | - Niall M Corcoran
- Department of Urology and Surgery, University of Melbourne, The Royal Melbourne Hospital, Australia; ; Australian Prostate Cancer Research Centre Epworth, Richmond, Australia
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Capek S, Howe BM, Tracy JA, García JJ, Amrami KK, Spinner RJ. Prostate cancer with perineural spread and dural extension causing bilateral lumbosacral plexopathy: case report. J Neurosurg 2015; 122:778-83. [DOI: 10.3171/2014.12.jns141339] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Perineural tumor spread in prostate cancer is emerging as a mechanism to explain select cases of neurological dysfunction and as a cause of morbidity and tumor recurrence. Perineural spread has been shown to extend from the prostate bed to the lumbosacral plexus and then distally to the sciatic nerve or proximally to the sacral and lumbar nerves and even intradurally. The authors present a case of a bilateral neoplastic lumbosacral plexopathy that can be explained anatomically as an extension of the same process: from one lumbosacral plexus to the contralateral one utilizing the dural sac as a bridge between the opposite sacral nerve roots. Their theory is supported by sequential progression of symptoms and findings on clinical examinations as well as high-resolution imaging (MRI and PET/CT scans). The neoplastic nature of the process was confirmed by a sciatic nerve fascicular biopsy. The authors believe that transmedian dural spread allows continuity of a neoplastic process from one side of the body to the other.
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Affiliation(s)
- Stepan Capek
- Departments of 1Neurosurgery,
- 2International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
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Mantini G, Fersino S, Alitto AR, Frascino V, Massaccesi M, Fionda B, Iorio V, Luzi S, Balducci M, Mattiucci GC, Di Nardo F, De Belvis A, Morganti AG, Valentini V. Intensified adjuvant treatment of prostate carcinoma: feasibility analysis of a phase I/II trial. BIOMED RESEARCH INTERNATIONAL 2014; 2014:480725. [PMID: 25093169 PMCID: PMC4100352 DOI: 10.1155/2014/480725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 05/31/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To perform a preliminary feasibility acute and late toxicity evaluation of an intensified and modulated adjuvant treatment in prostate cancer (PCa) patients after radical prostatectomy. MATERIAL AND METHODS A phase I/II has been designed. Eligible patients were 79 years old or younger, with an ECOG of 0-2, previously untreated, histologically proven prostate adenocarcinoma with no distant metastases, pT2-4 N0-1, and with at least one of the following risk factors: capsular perforation, positive surgical margins, and seminal vesicle invasion. All patients received a minimum dose on tumor bed of 64.8 Gy, or higher dose (70.2 Gy; 85.4%), according to the pathological stage, pelvic lymph nodes irradiation (57.7%), and/or hormonal therapy (69.1%). RESULTS 123 patients were enrolled and completed the planned treatment, with good tolerance. Median follow-up was 50.6 months. Grade 3 acute toxicity was only 2.4% and 3.3% for genitourinary (GU) and gastrointestinal (GI) tract, respectively. No patient had late grade 3 GI toxicity, and the GU grade 3 toxicity incidence was 5.8% at 5 years. 5-year BDSF was 90.2%. CONCLUSIONS A modulated and intensified adjuvant treatment in PCa was feasible in this trial. A further period of observation can provide a complete assessment of late toxicity and confirm the BDSF positive results.
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Affiliation(s)
- Giovanna Mantini
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Sergio Fersino
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Anna Rita Alitto
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Vincenzo Frascino
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Mariangela Massaccesi
- Unità Operativa di Radioterapia, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Crt. Tappino 35, 86100 Campobasso, Italy
| | - Bruno Fionda
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Vincenzo Iorio
- Dipartimento di Diagnostica per Immagini e Radioterapia, Policlinico Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Stefano Luzi
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Mario Balducci
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Gian Carlo Mattiucci
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Francesco Di Nardo
- Istituto di Igiene e Medicina Preventiva, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Antonio De Belvis
- Istituto di Igiene e Medicina Preventiva, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
| | - Alessio Giuseppe Morganti
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
- Unità Operativa di Radioterapia, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Crt. Tappino 35, 86100 Campobasso, Italy
| | - Vincenzo Valentini
- Unità Operativa di Radioterapia, Dipartimento di Bio-Immagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy
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Andersen S, Richardsen E, Nordby Y, Ness N, Størkersen O, Al-Shibli K, Donnem T, Bertilsson H, Busund LT, Angelsen A, Bremnes RM. Disease-specific outcomes of radical prostatectomies in Northern Norway; a case for the impact of perineural infiltration and postoperative PSA-doubling time. BMC Urol 2014; 14:49. [PMID: 24929427 PMCID: PMC4067377 DOI: 10.1186/1471-2490-14-49] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 05/28/2014] [Indexed: 12/26/2022] Open
Abstract
Background Prostate cancer is the most common male malignancy and a mayor cause of mortality in the western world. The impact of clinicopathological variables on disease related outcomes have mainly been reported from a few large US series, most of them not reporting on perineural infiltration. We therefore wanted to investigate relevant cancer outcomes in patients undergoing radical prostatectomy in two Norwegian health regions with an emphasis on the impact of perineural infiltration (PNI) and prostate specific antigen- doubling time (PSA-DT). Methods We conducted a retrospective analysis of 535 prostatectomy patients at three hospitals between 1995 and 2005 estimating biochemical failure- (BFFS), clinical failure- (CFFS) and prostate cancer death-free survival (PCDFS) with the Kaplan-Meier method. We investigated clinicopathological factors influencing risk of events using cox proportional hazard regression. Results After a median follow-up of 89 months, 170 patients (32%) experienced biochemical failure (BF), 36 (7%) experienced clinical failure and 15 (3%) had died of prostate cancer. pT-Stage (p = 0.001), preoperative PSA (p = 0.047), Gleason Score (p = 0.032), non-apical positive surgical margins (PSM) (p = 0.003) and apical PSM (p = 0.031) were all independently associated to BFFS. Gleason score (p = 0.019), PNI (p = 0.012) and non-apical PSM (p = 0.002) were all independently associated to CFFS while only PNI (P = 0.047) and subgroups of Gleason score were independently associated to PCDFS. After BF, patients with a shorter PSA-DT had independent and significant worse event-free survivals than patients with PSA-DT > 15 months (PSA-DT = 3-9 months, CFFS HR = 6.44, p < 0.001, PCDFS HR = 13.7, p = 0.020; PSA-DT < 3 months, CFFS HR = 11.2, p < 0.001, PCDFS HR = 27.5, p = 0.006). Conclusions After prostatectomy, CFFS and PCDFS are variable, but both are strongly associated to Gleason score and PNI. In patients with BF, PSA-DT was most strongly associated to CF and PCD. Our study adds weight to the importance of PSA-DT and re-launches PNI as a strong prognosticator for clinically relevant endpoints.
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Affiliation(s)
- Sigve Andersen
- Institute of Clinical Medicine, The Arctic University of Norway, Tromso, Norway.
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Cozzi G, Rocco BM, Grasso A, Rosso M, Abed El Rahman D, Oliva I, Talso M, Costa B, Tafa A, Palumbo C, Gadda F, Rocco F. Perineural invasion as a predictor of extraprostatic extension of prostate cancer: a systematic review and meta-analysis. Scand J Urol 2013; 47:443-8. [PMID: 23495828 DOI: 10.3109/21681805.2013.776106] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A systematic review of the literature was performed to assess the relationship between the presence of perineural invasion (PNI) at prostate biopsy and extraprostatic extension (EPE) of prostate cancer. In August 2012, Medline, Embase, Scopus and Web of Science databases were searched. A "free-text" protocol using the terms "perineural invasion prostate cancer" was applied. Studies published only as abstracts and reports from meetings were not included in this review. In total, 341 records were retrieved from Medline, 507 from Embase, 374 from Scopus and 65 from the Web of Science database. The records were reviewed to identify studies correlating the presence of PNI with that of EPE. A cumulative analysis was conducted using Review Manager software v. 5.1 (Cochrane Collaboration, Oxford, UK). In univariate analysis, PNI showed a statistically significant association with pT3 tumours (p < 0.00001), which could be observed for both pT3a (p < 0.0001) and pT3b (p < 0.0001). In conclusion, the cumulative analysis shows a statistically significant higher incidence of EPE in patients who had PNI at needle biopsy. The main limitation of the analysis was that it was not possible to perform a multivariate analysis. Further attempts to build a nomogram for the prediction of EPE could include the presence of PNI at needle biopsy.
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Affiliation(s)
- Gabriele Cozzi
- Università degli Studi di Milano, Clinica Urologica I, Fondazione IRCCS, Ca' Granda - Ospedale Maggiore Policlinico , Milan , Italy
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