1
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Zhao J, Sun G, Zhao F, Chen J, Zhu S, Xu N, Liu H, Liang J, Hu X, Zhang X, Ni Y, Dai J, Wang Z, Shen P, Liu Z, Chen N, Liu J, Zeng H. The therapeutic efficacy of radical prostatectomy and external beam radiation therapy in patients with different pathological patterns of prostate cancer. Asian J Surg 2023; 46:4178-4185. [PMID: 36376185 DOI: 10.1016/j.asjsur.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/03/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We aim to investigate the prognostic value of different pathological patterns of non-adenocarcinoma prostate cancers (PCa) in radical prostatectomy (RP) and external beam radiation therapy (EBRT). METHODS Data of 470,258 localized PCa patients between 2004 and 2016 were collected from the Surveillance, Epidemiology, and End Results database. Propensity score matching was performed to balance the baseline characteristics of patients in different groups. Kaplan-Meier curves and Cox regression were used for survival analysis. Overall survival (OS) and cancer-specific survival (CSS) were set as endpoints. RESULTS Totally, 1044 patients with non-adenocarcinoma patterns of PCa were included. Patients with small cell neuroendocrine carcinoma (SCNC) and neuroendocrine differentiation (NED) harbored the worst prognosis in both RP and EBRT among all pathological groups. RP exhibited superior effects to EBRT for this group of cases. Ductal carcinoma (DA) was also related to poorer survival outcomes versus PAC in both local therapies. Yet, for men with DA, both RP and EBRT still improved patients' prognosis against no local therapy (NLT), with RP being the superior modality. Cases harboring mucinous adenocarcinoma (MA) and signet ring cell carcinoma (SRCC) shared comparable clinical outcomes to men with PAC. However, for cases with MA, neither RP nor EBRT was related to better survival outcomes against NLT, while for patients with SRCC, both RP and EBRT prolonged patients' survival with similar effects. CONCLUSIONS Our study provided a comprehensive view of the treatment effect of RP and EBRT in non-adenocarcinoma PCa patients. These findings could facilitate clinicians in making therapeutic decision-making for non-adenocarcinoma patients.
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Affiliation(s)
- Jinge Zhao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Guangxi Sun
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Fengnian Zhao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Junru Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Sha Zhu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Nanwei Xu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Haoyang Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Jiayu Liang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Xu Hu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Xingming Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yuchao Ni
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Jindong Dai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Zhipeng Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Pengfei Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Zhenhua Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Ni Chen
- Department of Pathology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Jiyan Liu
- Department of Biotherapy, West China Hospital, Sichuan University, 610041, Chengdu, China.
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, 610041, Chengdu, China.
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2
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Hidden clues in prostate cancer - Lessons learned from clinical and pre-clinical approaches on diagnosis and risk stratification. Cancer Lett 2022; 524:182-192. [PMID: 34687792 DOI: 10.1016/j.canlet.2021.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/17/2021] [Accepted: 10/13/2021] [Indexed: 12/18/2022]
Abstract
The heterogeneity of prostate cancer is evident at clinical, morphological and molecular levels. To aid clinical decision making, a three-tiered system for risk stratification is used to designate low-, intermediate-, and high-risk of disease progression. Intermediate-risk prostate cancers are the most frequently diagnosed, and even with common diagnostic features, can exhibit vastly different clinical progression. Thus, improved risk stratification methods are needed to better predict patient outcomes. Here, we provide an overview of the improvements in diagnosis/prognosis arising from advances in pathology reporting of prostate cancer, which can improve risk stratification, especially for patients with intermediate-risk disease. This review discusses updates to pathology reporting of morphological growth patterns, and proposes the utility of integrating prognostic biomarkers or innovative imaging techniques to enhance clinical decision-making. To complement clinical studies, experimental approaches using patient-derived tumors have highlighted important cellular and morphological features associated with aggressive disease that may impact treatment response. The intersection of urology, pathology and scientific disciplines is required to work towards a common goal of understanding disease pathogenesis, improving the stratification of patients with intermediate-risk disease and subsequently defining optimal treatment strategies using precision-based approaches.
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3
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Kannan A, Clouston D, Frydenberg M, Ilic D, Karim MN, Evans SM, Toivanen R, Risbridger GP, Taylor RA. Neuroendocrine cells in prostate cancer correlate with poor outcomes: a systematic review and meta-analysis. BJU Int 2021; 130:420-433. [PMID: 34784097 DOI: 10.1111/bju.15647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 11/04/2021] [Accepted: 11/11/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To perform a systematic review and meta-analysis of the literature to understand the variation in the reporting of neuroendocrine staining and determine the influence of reporting neuroendocrine staining at diagnosis on patient outcomes. METHODS Medical databases were searched to identify studies in which adenocarcinoma specimens were stained with any of the following four neuroendocrine markers: chromogranin A (CgA), neuron-specific enolase (NSE), synaptophysin and CD56. The prevalence of neuroendocrine staining and correlation of the prevalence of neuroendocrine staining to patient outcomes were analysed using a random-effects model. All statistical tests were two-sided. RESULTS Sixty-two studies spanning 7616 patients were analysed. The pooled prevalence for the most common marker, CgA (41%), was similar to that of NSE (39%) and higher than that of synaptophysin (31%). The prevalence of CgA staining was significantly influenced by reporting criteria, where objective thresholds reduced the variation in prevalence to 26%. No correlation was found between CgA prevalence and tumour grade. Patients positive for CgA staining using objective criteria had more rapid biochemical progression (hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.49 to 2.65) and poorer prostate cancer-specific survival (HR 7.03, 95% CI 2.55 to 19.39) compared to negative patients, even among those with low-risk cancers. CONCLUSION Discrepancies in the reported prevalence of neuroendocrine cells in adenocarcinoma are driven by the inconsistent scoring criteria. This study unequivocally demonstrates that when neuroendocrine cell staining is assessed with objective criteria it identifies patients with poor clinical outcomes. Future studies are needed to determine the exact quantifiable thresholds for use in reporting neuroendocrine cell staining to identify patients at higher risk of progression.
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Affiliation(s)
- Ashwini Kannan
- Department of Anatomy and Developmental Biology and Department of Physiology, Biomedicine Discovery Institute, Cancer Program, Monash University, Melbourne, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | | | - Mark Frydenberg
- Department of Anatomy and Developmental Biology and Department of Physiology, Biomedicine Discovery Institute, Cancer Program, Monash University, Melbourne, Vic., Australia.,Department of Surgery, Monash University, Melbourne, Vic., Australia.,Department of Urology, Cabrini Institute, Cabrini Health, Melbourne, Vic., Australia
| | - Dragan Ilic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Md Nazmul Karim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Sue M Evans
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Victorian Cancer Registry, Cancer Council Victorian, Melbourne, Vic., Australia
| | - Roxanne Toivanen
- Department of Anatomy and Developmental Biology and Department of Physiology, Biomedicine Discovery Institute, Cancer Program, Monash University, Melbourne, Vic., Australia.,Prostate Cancer Research Program, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Sir Peter MacCallum, Department of Oncology, University of Melbourne, Parkville, Vic., Australia
| | - Gail P Risbridger
- Department of Anatomy and Developmental Biology and Department of Physiology, Biomedicine Discovery Institute, Cancer Program, Monash University, Melbourne, Vic., Australia.,Prostate Cancer Research Program, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Sir Peter MacCallum, Department of Oncology, University of Melbourne, Parkville, Vic., Australia
| | - Renea A Taylor
- Department of Anatomy and Developmental Biology and Department of Physiology, Biomedicine Discovery Institute, Cancer Program, Monash University, Melbourne, Vic., Australia.,Prostate Cancer Research Program, Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Sir Peter MacCallum, Department of Oncology, University of Melbourne, Parkville, Vic., Australia
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4
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Mankuzhy NP, Almahariq MF, Ye H, Amin M, Stone B, Krauss DJ. Investigation of the Prognostic Significance of Neuroendocrine Differentiation in Gleason Score 7 to 10 Prostate Adenocarcinoma in Patients With Distant Metastasis After Definitive Radiotherapy. Am J Clin Pathol 2021; 155:879-886. [PMID: 33283224 DOI: 10.1093/ajcp/aqaa199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES We investigated the prognostic implications of neuroendocrine differentiation (NED) in prostate adenocarcinoma detected by chromogranin A (CgA) in patients who developed distant metastasis (DM) after radiotherapy. METHODS Patients with Gleason score 7 to 10 conventional acinar prostate adenocarcinoma treated with definitive radiotherapy and with core biopsy CgA staining completed were reviewed. Patients who developed DM, defined as disease beyond the primary tumor or pelvic lymph nodes, underwent detailed chart review. Statistical analysis included Kaplan-Meier estimates and descriptive statistics to compare based on quantification of CgA staining. RESULTS Thirty-five patients had confirmed DM. Twenty-five patients had less than 1% of cells staining positive for CgA, and 10 patients had more than 1%. Median overall survival (OS) time was 3.26 and 1.04 years, respectively (P = .52). Median cause-specific survival (CSS) was 6.15 and 1.04 years, respectively (P = .21). Fifty-six percent of patients with CgA less than 1% died of prostate cancer compared with 90% of those with CgA more than 1% (P = .059). There were no significant differences in sites of metastatic disease or administration of systemic therapies. CONCLUSIONS No significant differences in OS and CSS were observed based on NED detected by CgA. Reduced median survival time and increased cancer-related death in cases with focal NED generates the hypothesis of inferior outcomes among patients with documented DM.
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Affiliation(s)
- Nikhil P Mankuzhy
- Oakland University William Beaumont School of Medicine, Rochester, MI
| | | | - Hong Ye
- Departments of Radiation Oncology, Royal Oak, MI
| | - Mitual Amin
- Departments of Pathology, Beaumont Health System, Royal Oak, MI
| | - Brandon Stone
- Departments of South Carolina Oncology Associates, Columbia
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5
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Ki67 in Gleason Pattern 3 as a Marker of the Presence of Higher-Grade Prostate Cancer. Appl Immunohistochem Mol Morphol 2020; 29:112-117. [DOI: 10.1097/pai.0000000000000835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 01/12/2020] [Indexed: 11/26/2022]
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6
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Saadeh H, Abdullah N, Erashdi M, Sughayer M, Al-Kadi O. Histopathologist-level quantification of Ki-67 immunoexpression in gastroenteropancreatic neuroendocrine tumors using semiautomated method. J Med Imaging (Bellingham) 2019; 7:012704. [PMID: 31824983 DOI: 10.1117/1.jmi.7.1.012704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/18/2019] [Indexed: 11/14/2022] Open
Abstract
The role of Ki-67 index in determining the prognosis and management of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) has become more important yet presents a challenging assessment dilemma. Although the precise method of Ki-67 index evaluation has not been standardized, several methods have been proposed, and each has its pros and cons. Our study proposes an imaging semiautomated informatics framework [semiautomated counting (SAC)] using the popular biomedical imaging tool "ImageJ" to quantify Ki-67 index of the GEP-NETs using camera-captured images of tumor hotspots. It aims to assist pathologists in achieving an accurate and rapid interpretation of Ki-67 index and better reproducibility of the results with minimal human interaction and calibration. Twenty cases of resected GEP-NETs with Ki-67 staining that had been done for diagnostic purposes have been randomly selected from the pathology archive. All of these cases were reviewed in a multidisciplinary cancer center between 2012 and 2019. For each case, the Ki-67 immunostained slide was evaluated and five camera-captured images at 40 × magnification were taken. Prints of images were used by three pathologists to manually count the tumor cells. The digital versions of the images were used for the semiautomated cell counting using ImageJ. Statistical analysis of the Ki-67 index correlation between the proposed method and the MC revealed strong agreement on all the cases evaluates ( n = 20 ), with an intraclass correlation coefficient of 0.993, "95% CI: 0.984 to 0.997." The results obtained from the SAC are promising and demonstrate the capability of this methodology for the development of reproducible and accurate semiautomated quantitative pathological assessments. ImageJ features are investigated carefully and accurately fine-tuned to obtain the optimal sequence of steps that will accurately calculate Ki-67 index. SAC is able to accurately grade all the cases evaluated perfectly mating histopathologists' manual grading, providing reliable and efficient solution for Ki-67 index assessment.
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Affiliation(s)
- Heba Saadeh
- The University of Jordan, King Abdullah II School for IT, Computer Science Department, Amman, Jordan
| | - Niveen Abdullah
- King Hussein Cancer Center, Department of Pathology and Laboratory Medicine, Al-Jubeiha, Amman, Jordan
| | - Madiha Erashdi
- King Hussein Cancer Center, Department of Pathology and Laboratory Medicine, Al-Jubeiha, Amman, Jordan
| | - Maher Sughayer
- King Hussein Cancer Center, Department of Pathology and Laboratory Medicine, Al-Jubeiha, Amman, Jordan
| | - Omar Al-Kadi
- The University of Jordan, King Abdullah II School for IT, Information Technology Department, Amman, Jordan
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7
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Rathke H, Holland-Letz T, Mier W, Flechsig P, Mavriopoulou E, Röhrich M, Kopka K, Hohenfellner M, Giesel FL, Haberkorn U, Kratochwil C. Response Prediction of 177Lu-PSMA-617 Radioligand Therapy Using Prostate-Specific Antigen, Chromogranin A, and Lactate Dehydrogenase. J Nucl Med 2019; 61:689-695. [PMID: 31653712 DOI: 10.2967/jnumed.119.231431] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/27/2019] [Indexed: 11/16/2022] Open
Abstract
Neuroendocrinelike transdifferentiation of prostate cancer adenocarcinomas correlates with serum levels of chromogranin A (CgA) and drives treatment resistance. The aim of this work was to evaluate whether CgA can serve as a response predictor for 177Lu-prostate-specific membrane antigen 617 (PSMA) radioligand therapy (RLT) in comparison with the established tumor markers. Methods: One hundred consecutive patients with metastasized castration-resistant prostate cancer scheduled for PSMA RLT were evaluated for prostate-specific antigen (PSA), lactate dehydrogenase (LDH), and CgA at baseline and in follow-up of PSMA RLT. Tumor uptake of PSMA ligand, a known predictive marker for response, was assessed as a control variable. Results: From the 100 evaluated patients, 35 had partial remission, 16 stable disease, 15 mixed response, and 36 progression of disease. Tumor uptake above salivary gland uptake translated into partial remission, with an odds ratio (OR) of 60.265 (95% confidence interval [CI], 5.038-720.922). Elevated LDH implied a reduced chance for partial remission, with an OR of 0.094 (95% CI, 0.017-0.518), but increased the frequency of progressive disease (OR, 2.717; 95% CI, 1.391-5.304). All patients who achieved partial remission had a normal baseline LDH. Factor-2 elevation of CgA increased the risk for progression, with an OR of 3.089 (95% CI, 1.302-7.332). Baseline PSA had no prognostic value for response prediction. Conclusion: In our cohort, baseline PSA had no prognostic value for response prediction. LDH was the marker with the strongest prognostic value, and elevated LDH increased the risk for progression of disease under PSMA RLT. Elevated CgA demonstrated a moderate impact as a negative prognostic marker in general but was explicitly related to the presence of liver metastases. Well in line with the literature, sufficient tumor uptake is a prerequisite to achieve tumor response.
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Affiliation(s)
- Hendrik Rathke
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Tim Holland-Letz
- Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Walter Mier
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Flechsig
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Eleni Mavriopoulou
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel Röhrich
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Kopka
- Division of Radiopharmaceutical Chemistry, German Cancer Research Center, Heidelberg, Germany
| | | | - Frederik Lars Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.,Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany; and.,Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
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8
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Kardoust Parizi M, Iwata T, Kimura S, Janisch F, Abufaraj M, Karakiewicz PI, Enikeev D, Rapoport LM, Hutterer G, Shariat SF. Focal Neuroendocrine Differentiation of Conventional Prostate Adenocarcinoma as a Prognostic Factor after Radical Prostatectomy: A Systematic Review and Meta-Analysis. Int J Mol Sci 2019; 20:ijms20061374. [PMID: 30893781 PMCID: PMC6471399 DOI: 10.3390/ijms20061374] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 01/06/2023] Open
Abstract
The biologic and prognostic value of focal neuroendocrine differentiation (NED) in conventional prostate adenocarcinoma (PC) patients who undergo radical prostatectomy (RP) remains controversial. In this systematic review and meta-analysis, we assessed the association of focal NED in conventional PC with oncological outcomes after RP. A literature search using PubMed, Scopus, Web of Science, and Cochrane Library was conducted on December 2018 to find relevant studies according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We used a fixed-effect model to analyze the impact of focal NED in RP specimen on progression-free survival defined by biochemical recurrence (BCR). A total of 16 studies with the outcomes of disease progression and survival were eligible. No patient in these studies received androgen deprivation therapy prior to RP. Eleven studies found no significant correlation between focal NED and outcomes of interest, while five studies reported a significant association of focal NED assessed by immunohistochemical chromogranin A or serotonin staining with BCR or survival. Focal NED was associated with higher BCR rates after RP with a pooled HR of 1.39 (95% CI 1.07‒1.81) in five studies. No heterogeneity was reported in this analysis (I2 = 21.7%, p = 0.276). In conclusion, focal NED in conventional PC is associated with worse prognosis after RP. Its presence should be reported in pathologic reports and its true clinical impact should be assessed in well-designed prospective controlled studies.
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Affiliation(s)
- Mehdi Kardoust Parizi
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria.
- Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Teheran 1411713135, Iran.
| | - Takehiro Iwata
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria.
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
| | - Shoji Kimura
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria.
- Department of Urology, Jikei University School of Medicine, Tokyo 105-8461, Japan.
| | - Florian Janisch
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria.
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria.
- Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman 11942, Jordan.
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC H3h 1s8, Canada.
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Institut du Cancer de Montréal, Montréal, QC H3h 1s8, Canada.
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow 119991, Russia.
| | - Leonid M Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow 119991, Russia.
| | - Georg Hutterer
- Department of Urology, Medical University Graz, A-8036 Graz, Austria.
| | - Shahrokh F Shariat
- Institute for Urology and Reproductive Health, Sechenov University, Moscow 119991, Russia.
- Department of Urology, Weill Cornell Medical College, New York, NY 10011, USA.
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
- Karl Landsteiner Institute of Urology and Andrology, A-1090 Vienna, Austria.
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9
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Zhang AY, Chiam K, Haupt Y, Fox S, Birch S, Tilley W, Butler LM, Knudsen K, Comstock C, Rasiah K, Grogan J, Mahon KL, Bianco-Miotto T, Ricciardelli C, Böhm M, Henshall S, Delprado W, Stricker P, Horvath LG, Kench JG. An analysis of a multiple biomarker panel to better predict prostate cancer metastasis after radical prostatectomy. Int J Cancer 2018; 144:1151-1159. [PMID: 30288742 DOI: 10.1002/ijc.31906] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/22/2018] [Indexed: 12/23/2022]
Abstract
A plethora of individual candidate biomarkers for predicting biochemical relapse in localized prostate cancer (PCa) have been proposed. Combined biomarkers may improve prognostication, and ensuring validation against more clinically relevant endpoints are required. The Australian PCa Research Centre NSW has contributed to numerous studies of molecular biomarkers associated with biochemical relapse. In the current study, these biomarkers were re-analyzed for biochemical relapse, metastatic relapse and PCa death with extended follow-up. Biomarkers of significance were then used to develop a combined prognostic model for clinical outcomes and validated in a large independent cohort. The discovery cohort (n = 324) was based on 12 biomarkers with a median follow-up of 16 years. Seven biomarkers were significantly associated with biochemical relapse. Three biomarkers were associated with metastases: AZGP1, Ki67 and PML. Only AZGP1 was associated with PCa death. In their individual and combinational forms, AZGP1 and Ki67 as a dual BM signature was the most robust predictor of metastatic relapse (AUC 0.762). The AZPG1 and Ki67 signature was validated in an independent cohort of 347 PCa patients. The dual BM signature of AZGP1 and Ki67 predicted metastasis in the univariable (HR 7.2, 95% CI, 1.6-32; p = 0.01) and multivariable analysis (HR 5.4, 95% CI, 1.2-25; p = 0.03). The dual biomarker signature marginally improved risk prediction compared to AZGP1 alone (AUC 0.758 versus 0.738, p < 0.001). Our findings indicate that biochemical relapse is not an adequate surrogate for metastasis or PCa death. The dual biomarker signature of AZGP1 and Ki67 offers a small benefit in predicting metastasis over AZGP1 alone.
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Affiliation(s)
- Alison Y Zhang
- Cancer Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,Chris O'Brien Lifehouse, Camperdown, NSW, Australia.,University of Sydney, Camperdown, NSW, Australia
| | - Karen Chiam
- Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, NSW, Australia
| | - Ygal Haupt
- Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | - Stephen Fox
- Peter MacCallum Cancer Centre, Parkville, VIC, Australia.,University of Melbourne, Parkville, VIC, Australia
| | - Simone Birch
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Wayne Tilley
- Freemason's Foundation Centre for Men's Health, University of Adelaide, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Lisa M Butler
- Freemason's Foundation Centre for Men's Health, University of Adelaide, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Karen Knudsen
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, US
| | - Clay Comstock
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, US
| | | | - Judith Grogan
- Cancer Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Kate L Mahon
- Cancer Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,Chris O'Brien Lifehouse, Camperdown, NSW, Australia.,Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Tina Bianco-Miotto
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide, SA, Australia
| | - Carmela Ricciardelli
- Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Maret Böhm
- Cancer Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Susan Henshall
- Union for International Cancer Control, Geneva, Switzerland
| | - Warick Delprado
- Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia
| | - Phillip Stricker
- Cancer Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,Department of Urology, St Vincent's Clinic, Darlinghurst, NSW, Australia
| | - Lisa G Horvath
- Cancer Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,Chris O'Brien Lifehouse, Camperdown, NSW, Australia.,University of Sydney, Camperdown, NSW, Australia.,Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - James G Kench
- Cancer Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,University of Sydney, Camperdown, NSW, Australia.,Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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10
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High immunoexpression of Ki67, EZH2, and SMYD3 in diagnostic prostate biopsies independently predicts outcome in patients with prostate cancer. Urol Oncol 2017; 36:161.e7-161.e17. [PMID: 29174711 DOI: 10.1016/j.urolonc.2017.10.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/05/2017] [Accepted: 10/31/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Overtreatment is a major concern in patients with prostate cancer (PCa). Prognostic biomarkers discriminating indolent from aggressive disease in prostate biopsy are urgently needed. We aimed to evaluate the prognostic value of Ki67, EZH2, LSD1, and SMYD3 immunoexpression in diagnostic biopsies from a cohort of PCa patients with long term follow-up. MATERIALS AND METHODS A series of 189 consecutive prostate biopsies diagnosed with PCa (1997-2001) in a cancer center was included in the study, with follow-up last updated in November 2016. Biopsies were reviewed and graded according to 2016 WHO criteria. Immunohistochemistry was performed in the most representative block. Nuclear staining was assessed using digital image analysis. Study outcomes included disease-specific, disease-free, and progression-free survival. Statistical analysis was tabulated using SPSS version 22.0. Survival curves and hazard ratios (HRs) were estimated using Kaplan-Meyer and Cox-regression models, respectively. Statistical significance was set at P<0.05. RESULTS The proportion of patients who completed the study was 177/189 (94%). In univariable analysis, high Ki67, EZH2, and SMYD3 immunoexpression associated with significantly worse disease-specific survival (HR = 1.86, 95% CI: 1.05-3.29; HR = 1.87, 95% CI: 1.10-3.27; HR = 2.68, 95% CI: 1.02-7.92). In multivariable analysis, the 3 biomarkers displayed significantly worse DSS adjusted for CAPRA score (HR = 1.78, 95% CI: 1.01-3.16; HR = 1.93, 95% CI: 1.12-3.32; HR = 2.71, 95% CI: 1.04-7.10). Among patients with low/intermediate risk CAPRA score, high Ki67 immunoexpression identified those more prone to experience disease recurrence (HR = 9.20, 95% CI: 1.27-66.44) and progression (HR = 2.97, 95% CI: 1.05-8.43). CONCLUSIONS High Ki67, EZH2, and SMYD3 immunoexpression, adjusted for standard clinicopathological parameters, independently predicts outcome in patients with PCa, at diagnosis. This might assist in discriminating indolent from aggressive PCa, improving treatment selection.
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11
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Li T, Hong X, Zhao J, Teng Y, Zheng J, Chen H, Chen H, Li H. Gelsolin-like actin-capping protein is associated with patient prognosis, cellular apoptosis and proliferation in prostate cancer. Biomark Med 2016; 10:1251-1260. [PMID: 27924630 DOI: 10.2217/bmm-2016-0186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
AIM To investigate the role of gelsolin-like actin-capping protein (CapG) in prostate cancer (PCa). MATERIALS & METHODS CapG expression and its correlation with clinicopathological characters and patient prognosis were analyzed in 76 cases of PCa by immunohistochemistry and qRT-PCR. Then, the influence of CapG downregulation on cell apoptosis and proliferation were assessed. RESULTS CapG expression in PCa was significantly higher compared with those in matched adjacent noncancerous prostate tissues, and significantly correlated with clinicopathological characters. Survival analysis indicated that CapG could be an independent prognostic factor in PCa. Moreover, CapG depletion significantly affected cellular proliferation and apoptosis by regulating Caspase 6/Caspase 9/Bcl-2/p-Akt/Akt signaling pathway. CONCLUSION CapG, as a potential biomarker in PCa, is associated with patient prognosis, cellular apoptosis and proliferation.
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Affiliation(s)
- Tieqiu Li
- Department of Urology, Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - Xiuqin Hong
- Institute of Gerontology, Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - Jie Zhao
- Department of Pathology, Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - Yili Teng
- Department of Urology, Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - Jue Zheng
- Department of Urology, Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - Hao Chen
- Department of Urology, Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - Henggui Chen
- Department of Urology, Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
| | - Huahua Li
- Department of Geriatric, Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, 410005, China
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12
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Angulo JC, Redondo C, Sánchez-Chapado M, Colás B, Ropero S, López JI. Survival predictors in patients with prostate adenocarcinoma with hormonal blockade. Pathol Res Pract 2016; 212:899-903. [PMID: 27502465 DOI: 10.1016/j.prp.2016.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/19/2016] [Accepted: 07/22/2016] [Indexed: 10/21/2022]
Abstract
Ki-67 index and clinical-pathological factors such as the Gleason score and the presence of neuroendocrine differentiation have been used for predicting survival in patients with prostate cancer. We examined prostate tissue from 45 patients with advanced prostate cancer who were treated with maximal androgen blockade and analysed their cancer-specific survival (CSS). We assessed the Gleason index, performed an immunohistochemical analysis of Ki-67 (MIB-1) and determined the presence of neuroendocrine differentiation (chromogranin A). A survival study was conducted using Kaplan-Meier curves (log-rank test) and a Cox regression analysis. Twenty-four patients (53.3%) died from the disease, with a mean follow-up of 68.7±7.7 months (56.6% CSS at 5 years and 31.8% at 10 years). In the univariate analysis, survival was associated with an interquartile distribution of Ki-67 (0-5, 6-12%, 13-25%, >25%; log-rank, p=0.01), Gleason 5 (total index 9-10; log-rank, p=0.002) and the presence of metastases during the diagnosis (M1; log-rank, p=0.004) but not to cT category (T3-T4; log-rank, p=0.26) or neuroendocrine differentiation (immunohistochemically positive tumour cell nests; log-rank, p=0.46). The multivariate analysis revealed that a Ki-67 index ≤12% (HR, 0.22; p=0.0009) and the absence of metastases (M0) during diagnosis (HR, 0.17; p=0.0002) were protective factors in this population. In conclusion, Ki-67 proliferation index and the lack of metastases at diagnosis predict CSS in patients with advanced prostate cancer who undergo hormonal blockade. Neuroendocrine differentiation in tumour tissue had no prognostic value in this study.
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Affiliation(s)
- Javier C Angulo
- Clinical Department, Faculty of Biomedical Sciences, European University of Madrid, Laureate International Universities, Madrid, Spain; Department of Urology, University Hospital of Getafe, Madrid, Spain
| | - Cristina Redondo
- Department of Urology, University Hospital of Getafe, Madrid, Spain
| | - Manuel Sánchez-Chapado
- Department of Urology, University Hospital Príncipe de Asturias, University of Alcala, Alcala de Henares, Madrid, Spain
| | - Begoña Colás
- Department of Systems Biology, Biochemical and Molecular Biology Teaching Unit, University of Alcala, Alcala de Henares, Madrid, Spain
| | - Santiago Ropero
- Department of Systems Biology, Biochemical and Molecular Biology Teaching Unit, University of Alcala, Alcala de Henares, Madrid, Spain
| | - José I López
- Department of Pathology, Cruces University Hospital, BioCruces Institute, University of the Basque Country (UPV/EHU), Barakaldo, Bizkaia, Spain.
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13
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Pascale M, Aversa C, Barbazza R, Marongiu B, Siracusano S, Stoffel F, Sulfaro S, Roggero E, Bonin S, Stanta G. The proliferation marker Ki67, but not neuroendocrine expression, is an independent factor in the prediction of prognosis of primary prostate cancer patients. Radiol Oncol 2016; 50:313-20. [PMID: 27679548 PMCID: PMC5030813 DOI: 10.1515/raon-2016-0033] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/28/2016] [Indexed: 12/23/2022] Open
Abstract
Background Neuroendocrine markers, which could indicate for aggressive variants of prostate cancer and Ki67 (a well-known marker in oncology for defining tumor proliferation), have already been associated with clinical outcome in prostate cancer. The aim of this study was to investigate the prognostic value of those markers in primary prostate cancer patients. Patients and methods NSE (neuron specific enolase), ChrA (chromogranin A), Syp (Synaptophysin) and Ki67 staining were performed by immunohistochemistry. Then, the prognostic impact of their expression on overall survival was investigated in 166 primary prostate cancer patients by univariate and multivariate analyses. Results NSE, ChrA, Syp and Ki67 were positive in 50, 45, 54 and 146 out of 166 patients, respectively. In Kaplan-Meier analysis only diffuse NSE staining (negative vs diffuse, p = 0.004) and Ki67 (≤ 10% vs > 10%, p < 0.0001) were significantly associated with overall survival. Ki67 expression, but not NSE, resulted as an independent prognostic factor for overall survival in multivariate analysis. Conclusions A prognostic model incorporating Ki67 expression with clinical-pathological covariates could provide additional prognostic information. Ki67 may thus improve prediction of prostate cancer outcome based on standard clinical-pathological parameters improving prognosis and management of prostate cancer patients.
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Affiliation(s)
- Mariarosa Pascale
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - Cinzia Aversa
- Department of Medical Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Renzo Barbazza
- Department of Medical Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Barbara Marongiu
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - Salvatore Siracusano
- Department of Medical Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Flavio Stoffel
- Department of Urology, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Sando Sulfaro
- Department of Laboratory Medicine, S.C. Pathology, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Enrico Roggero
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - Serena Bonin
- Department of Medical Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Giorgio Stanta
- Department of Medical Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
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14
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Tretiakova MS, Wei W, Boyer HD, Newcomb LF, Hawley S, Auman H, Vakar-Lopez F, McKenney JK, Fazli L, Simko J, Troyer DA, Hurtado-Coll A, Thompson IM, Carroll PR, Ellis WJ, Gleave ME, Nelson PS, Lin DW, True LD, Feng Z, Brooks JD. Prognostic value of Ki67 in localized prostate carcinoma: a multi-institutional study of >1000 prostatectomies. Prostate Cancer Prostatic Dis 2016; 19:264-70. [PMID: 27136741 DOI: 10.1038/pcan.2016.12] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/17/2016] [Accepted: 03/08/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Expanding interest in and use of active surveillance for early state prostate cancer (PC) has increased need for prognostic biomarkers. Using a multi-institutional tissue microarray resource including over 1000 radical prostatectomy samples, we sought to correlate Ki67 expression captured by an automated image analysis system with clinicopathological features and validate its utility as a clinical grade test in predicting cancer-specific outcomes. METHODS After immunostaining, the Ki67 proliferation index (PI) of tumor areas of each core (three cancer cores/case) was analyzed using a nuclear quantification algorithm (Aperio). We assessed whether Ki67 PI was associated with clinicopathological factors and recurrence-free survival (RFS) including biochemical recurrence, metastasis or PC death (7-year median follow-up). RESULTS In 1004 PCs (∼4000 tissue cores) Ki67 PI showed significantly higher inter-tumor (0.68) than intra-tumor variation (0.39). Ki67 PI was associated with stage (P<0.0001), seminal vesicle invasion (SVI, P=0.02), extracapsular extension (ECE, P<0.0001) and Gleason score (GS, P<0.0001). Ki67 PI as a continuous variable significantly correlated with recurrence-free, overall and disease-specific survival by multivariable Cox proportional hazard model (hazards ratio (HR)=1.04-1.1, P=0.02-0.0008). High Ki67 score (defined as ⩾5%) was significantly associated with worse RFS (HR=1.47, P=0.0007) and worse overall survival (HR=2.03, P=0.03). CONCLUSIONS In localized PC treated by radical prostatectomy, higher Ki67 PI assessed using a clinical grade automated algorithm is strongly associated with a higher GS, stage, SVI and ECE and greater probability of recurrence.
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Affiliation(s)
| | - W Wei
- MD Anderson Cancer Center, Houston, TX, USA
| | - H D Boyer
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - L F Newcomb
- University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - S Hawley
- Canary Foundation, Redwood City, CA, USA
| | - H Auman
- Canary Foundation, Redwood City, CA, USA
| | | | | | - L Fazli
- University of British Columbia, Vancouver, BC, Canada
| | - J Simko
- University of California at San Francisco, CA, USA
| | - D A Troyer
- Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - I M Thompson
- University of Texas Health Sciences Center at San Antonio, TX, USA
| | - P R Carroll
- University of California at San Francisco, CA, USA
| | - W J Ellis
- University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - M E Gleave
- University of British Columbia, Vancouver, BC, Canada
| | - P S Nelson
- University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - D W Lin
- University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - L D True
- University of Washington, Seattle, WA, USA
| | - Z Feng
- MD Anderson Cancer Center, Houston, TX, USA
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15
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Prognostic relevance of proliferation markers (Ki-67, PHH3) within the cross-relation of ERG translocation and androgen receptor expression in prostate cancer. Pathology 2015; 47:629-36. [DOI: 10.1097/pat.0000000000000320] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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16
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Li S, Wu Z, Chen Y, Kang Z, Wang H, He P, Zhang X, Hu T, Zhang Q, Cai Y, Xu X, Guan M. Diagnostic and prognostic value of tissue and circulating levels of Ephrin-A2 in prostate cancer. Tumour Biol 2015; 37:5365-74. [PMID: 26561474 DOI: 10.1007/s13277-015-4398-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022] Open
Abstract
Ephrin-A2, a member of the Eph/ephrin family, is associated with tumorigenesis and tumor progression. This study aimed to assess the diagnostic and prognostic value of both serum and tissue levels of Ephrin-A2 in prostate cancer (PCa) management. One hundred and forty-five frozen prostate tissues, 55 paraffin-embedded prostate tissues, 88 serum samples, and seven prostate cell lines (RWPE-1, LNCaP, LNCaP-LN3, PC-3, PC-3M, PC-3M-LN4, and DU145) were examined via quantitative reverse transcription-PCR (qRT-PCR), immunohistochemistry, enzyme-linked immunosorbent assay, and western blotting. Induced Ephrin-A2 messenger RNA (mRNA) or protein expression was detected in 8.6 % (5/58) benign prostatic hyperplasia (BPH), 59.8 % (52/87) PCa, and five prostate cancer cell lines. Ephrin-A2 immunostaining was present in 6.7 % (1/15) patients with BPHs and 62.5 % (25/40) clinically localized PCa. Accordingly, serum Ephrin-A2 was significantly higher in PCa patients compared to those in the BPH patients and controls (P < 0.001). The expression of Ephrin-A2 was higher in tumor patients with an elevated Gleason score or T3-T4 staging. Ephrin-A2 expression was correlated with Ki-67 expression in PCa patients, both at the gene scale and protein level. Our data indicate that Ephrin-A2 is a potential diagnostic and prognostic biomarker and a promising molecular therapeutic target to attenuate prostate cancer progression.
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Affiliation(s)
- Shibao Li
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical School, Fudan University, 12 Central Urumqi Road, Shanghai, China.,Department of Laboratory Medicine, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu, China
| | - Zhiyuan Wu
- Department of Laboratory Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Yuming Chen
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical School, Fudan University, 12 Central Urumqi Road, Shanghai, China
| | - Zhihua Kang
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical School, Fudan University, 12 Central Urumqi Road, Shanghai, China
| | - Hua Wang
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical School, Fudan University, 12 Central Urumqi Road, Shanghai, China
| | - Ping He
- Department of Laboratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Xinju Zhang
- Central Laboratory, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Tingting Hu
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical School, Fudan University, 12 Central Urumqi Road, Shanghai, China
| | - Qunfeng Zhang
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical School, Fudan University, 12 Central Urumqi Road, Shanghai, China.,Department of Laboratory Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Yanqun Cai
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical School, Fudan University, 12 Central Urumqi Road, Shanghai, China.,Department of Laboratory Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, China
| | - Xiao Xu
- Central Laboratory, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Ming Guan
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical School, Fudan University, 12 Central Urumqi Road, Shanghai, China. .,Department of Laboratory Medicine, Huashan Hospital North, Fudan University, Shanghai, China. .,Central Laboratory, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China.
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17
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Mathieu R, Shariat SF, Seitz C, Karakiewicz PI, Fajkovic H, Sun M, Lotan Y, Scherr DS, Tewari A, Montorsi F, Briganti A, Rouprêt M, Lucca I, Margulis V, Rink M, Kluth LA, Rieken M, Bachman A, Xylinas E, Robinson BD, Bensalah K, Margreiter M. Multi-institutional validation of the prognostic value of Ki-67 labeling index in patients treated with radical prostatectomy. World J Urol 2014; 33:1165-71. [DOI: 10.1007/s00345-014-1421-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 10/14/2014] [Indexed: 11/28/2022] Open
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18
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Surcel CI, van Oort IM, Sooriakumaran P, Briganti A, De Visschere PJL, Fütterer JJ, Ghadjar P, Isbarn H, Ost P, van den Bergh RCN, Yossepowitch O, Giannarini G, Ploussard G. Prognostic effect of neuroendocrine differentiation in prostate cancer: A critical review. Urol Oncol 2014; 33:265.e1-7. [PMID: 25238700 DOI: 10.1016/j.urolonc.2014.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 08/13/2014] [Accepted: 08/13/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND The multiple pathways that are involved in neuroendocrine differentiation (NED) in prostate cancer (PCa) are poorly elucidated. Evidence suggests that several environmental triggers induce NED leading to the adaptation of PCa to its close environment to maintain cell proliferation. Nevertheless, there is conflicting evidence regarding the prognostic role of NED in PCa. METHODS In this review, we aimed to summarize all available data about NED and to assess the prognostic role of NED in disease progression and therapy resistance, and its role in routine clinical practice. This review was based on articles found through a PubMed literature search between 1993 and 2013. The study outcome measure was the effect of NED on oncologic outcomes at each PCa stage. RESULTS In total, 59 articles reporting on the effect of NED on oncologic outcomes have been selected. In clinical practice, immunostaining for NED markers could have interesting predictive value for assessing the oncologic outcomes in patients receiving androgen-deprivation therapy. Thus, patients with high NED burden may be candidates for more aggressive treatment strategies targeting NED pathways. Conversely, strong evidence is lacking concerning its potential independent prognostic value in hormone-naïve PCa. CONCLUSIONS Current published data are not sufficient to recommend the use of NE markers in routine practice, particularly at early PCa stage.
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Affiliation(s)
- Cristian I Surcel
- Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Inge M van Oort
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Prasanna Sooriakumaran
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Jurgen J Fütterer
- Department of Radiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Hendrik Isbarn
- Department of Urology, Regio Clinic Wedel, Wedel, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Piet Ost
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | | | - Ofer Yossepowitch
- Department of Urology, Rabin Medical Center-Beilinson, Petach-Tikva, Israel; Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | - Gianluca Giannarini
- Department of Experimental and Clinical Medical Sciences, Urology Unit, University of Udine, Udine, Italy
| | - Guillaume Ploussard
- Department of Urology, CHU Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris 7 Diderot, Paris, France.
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Costa-Pinheiro P, Patel HRH, Henrique R, Jerónimo C. Biomarkers and personalized risk stratification for patients with clinically localized prostate cancer. Expert Rev Anticancer Ther 2014; 14:1349-58. [PMID: 25148431 DOI: 10.1586/14737140.2014.952288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Prostate cancer (PCa) is the most common neoplasia among men in developed countries and a leading cause of cancer-related morbidity and mortality. PCa is a very heterogeneous disease, both clinically and biologically. Currently, it is difficult to stratify patients into risk groups that entail different disease management. Therefore, a personalized view of this disease is mandatory, through the development of new and more accurate biomarkers that may help clinicians to stratify patients according to threat that PCa poses for each patient. Hence, this review focuses on recent developments of molecular and immunohistochemical biomarkers for PCa risk stratification that might enable a personalized approach to PCa patients. However, despite the increasing amount of available data, there is also an urgent need to translate the most promising biomarkers for clinical use through large multicenter validation trials. Ultimately, these will contribute for an improved clinical management of PCa patients.
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Affiliation(s)
- Pedro Costa-Pinheiro
- Cancer Biology and Epigenetics Group - Research Center of Portuguese Oncology Institute - Porto (CI-IPOP), LAB 3, F Building, 1st floor, Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal
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20
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Characterization of prostate neuroendocrine cancers and therapeutic management: a literature review. Prostate Cancer Prostatic Dis 2014; 17:220-6. [DOI: 10.1038/pcan.2014.17] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 02/25/2014] [Accepted: 03/18/2014] [Indexed: 12/31/2022]
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21
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Koukourakis MI, Giatromanolaki A, Panteliadou M, Pouliliou SE, Chondrou PS, Mavropoulou S, Sivridis E. Lactate dehydrogenase 5 isoenzyme overexpression defines resistance of prostate cancer to radiotherapy. Br J Cancer 2014; 110:2217-23. [PMID: 24714743 PMCID: PMC4007238 DOI: 10.1038/bjc.2014.158] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 02/28/2014] [Accepted: 03/03/2014] [Indexed: 12/17/2022] Open
Abstract
Background: Radiotherapy provides high-cure rates in prostate cancer. Despite its overall slow clinical growth, high proliferation rates documented in a subset of tumours relate to poor radiotherapy outcome. This study examines the role of anaerobic metabolism in prostate cancer growth and resistance to radiotherapy. Methods: Biopsy samples from 83 patients with prostate cancer undergoing radical hypofractionated and accelerated radiotherapy were analysed for MIB1 proliferation index and for lactate dehydrogenase isoenzyme LDH5, a marker of tumour anaerobic metabolism. Ninety-five surgical samples were in parallel analysed. Correlation with histopathological variables, PSA and radiotherapy outcome was assessed. Dose–response experiments were performed in PC3 and DU145 cancer cell lines. Results: High MIB1 index (noted in 25% of cases) was directly related to Gleason score (P<0.0001), T3-stage (P=0.0008) and PSA levels (P=0.03). High LDH5 (noted in 65% of cases) was directly related to MIB1 index (P<0.0001), Gleason score (P=0.02) and T3-stage (P=0.001). High Gleason score, MIB1, LDH5 and PSA levels were significantly related to poor BRFS (P=0.007, 0.01, 0.03 and 0.01, respectively). High Gleason score (P=0.04), LDH5 (P=0.01) and PSA levels (P=0.003) were significantly related to local recurrence. MIB1 and T-stage did not affect local control. Silencing of LDHA gene in both prostate cancer cell lines resulted in significant radiosensitisation. Conclusions: LDH5 overexpression is significantly linked to highly proliferating prostate carcinomas and with biochemical failure and local relapse following radiotherapy. Hypoxia and LDHA targeting agents may prove useful to overcome radioresistance in a subgroup of prostate carcinomas with anaerobic metabolic predilection.
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Affiliation(s)
- M I Koukourakis
- Department of Radiotherapy/Oncology, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - A Giatromanolaki
- Department of Pathology, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - M Panteliadou
- Department of Radiotherapy/Oncology, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - S E Pouliliou
- Department of Radiotherapy/Oncology, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - P S Chondrou
- Department of Radiotherapy/Oncology, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - S Mavropoulou
- Department of Pathology, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - E Sivridis
- Department of Pathology, Democritus University of Thrace, Alexandroupolis 68100, Greece
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Fisher G, Yang ZH, Kudahetti S, Møller H, Scardino P, Cuzick J, Berney DM. Prognostic value of Ki-67 for prostate cancer death in a conservatively managed cohort. Br J Cancer 2013; 108:271-7. [PMID: 23329234 PMCID: PMC3566811 DOI: 10.1038/bjc.2012.598] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Standard clinical parameters cannot accurately differentiate indolent from aggressive prostate cancer. Our previous work showed that immunohistochemical (IHC) Ki-67 improved prediction of prostate cancer death in a cohort of conservatively treated clinically localised prostate cancers diagnosed by transurethral resection of the prostate (TURP). Here, we present results in a more clinically relevant needle biopsy cohort. Methods: Biopsy specimens were microarrayed. The percentage of Ki-67 positively stained malignant cells per core was measured and the maximum score per individual used in analysis of time to death from prostate cancer using a Cox proportional hazards model. Results: In univariate analysis (n=293), the hazard ratio (HR) (95% confidence intervals) for dichotomous Ki-67 (⩽10%, >10%) was 3.42 (1.76, 6.62) χ2 (1 df)=9.8, P=0.002. In multivariate analysis, Ki-67 added significant predictive information to that provided by Gleason score and prostate-specific antigen (HR=2.78 (1.42, 5.46), χ2 (1 df)=7.0, P=0.008). Conclusion: The IHC Ki-67 scoring on prostate needle biopsies is practicable and yielded significant prognostic information. It was less informative than in the previous TURP cohort where tumour samples were larger and more comprehensive, but in more contemporary cohorts with larger numbers of biopsies per patient, Ki-67 may prove a more powerful biomarker.
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Affiliation(s)
- G Fisher
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
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Objective Quantification of the Ki67 Proliferative Index in Neuroendocrine Tumors of the Gastroenteropancreatic System. Am J Surg Pathol 2012; 36:1761-70. [DOI: 10.1097/pas.0b013e318263207c] [Citation(s) in RCA: 200] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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The role of treatment modality on the utility of predictive tissue biomarkers in clinical prostate cancer: a systematic review. J Cancer Res Clin Oncol 2012. [PMID: 23187933 DOI: 10.1007/s00432-012-1351-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Tissue biomarkers could pivotally improve clinical outcome prediction following prostate cancer therapy. Clinically, prostate cancer is managed by diverse treatment modalities whose individual influence on a biomarker's predictive ability is not well understood and poorly investigated in the literature. OBJECTIVE We conducted a systematic review to assess the predictive value of biomarkers in different treatment contexts in prostate cancer. STUDY METHODOLOGY A literature search was performed using the MeSH headings "prostate neoplasms" and "biological markers". Rigorous selection criteria identified studies correlating expression with clinical outcomes from primary androgen deprivation therapy (ADT), radical prostatectomy and radiotherapy (± neoadjuvant ADT). STUDY RESULTS Of 10,668 studies identified, 481 papers matched initial inclusion criteria. Following rescreening, 384 studies identified 236 individual tissue biomarkers, of which 29 were predictive on multivariate analysis in at least 2 independent cohorts. The majority were only tested in surgical cohorts. Only 8 predictive biomarkers were tested across all 3 treatments with Ki67 identified as universal predictive marker. p16 showed potential for treatment stratification between surgery and radiotherapy but needs further validation in independent studies. CONCLUSIONS Despite years of research, very few tissue biomarkers retain predictive value in independent validation across therapy context. Currently, none have conclusive ability to help treatment selection. Future biomarker research should consider the therapy context and use uniform methodology and evaluation criteria.
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Jeetle SS, Fisher G, Yang ZH, Stankiewicz E, Møller H, Cooper CS, Cuzick J, Berney DM. Neuroendocrine differentiation does not have independent prognostic value in conservatively treated prostate cancer. Virchows Arch 2012; 461:103-7. [PMID: 22767265 DOI: 10.1007/s00428-012-1259-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 05/10/2012] [Accepted: 05/28/2012] [Indexed: 11/26/2022]
Abstract
In vitro studies have implicated neuroendocrine differentiation in the development of hormone resistant prostate cancer following administration of androgen blockers. Studies on clinical material are equivocal. We wished to understand the significance of neuroendocrine differentiation in our large and well-characterised cohort of clinically localised prostate cancer, treated conservatively. Immunohistochemical expression of chromogranin-A was assessed semi-quantitatively on tissue samples of 806 patients in a tissue microarray approach. The correlation of expression with 10-year prostate cancer survival was examined. Multivariate analysis including contemporary Gleason score was performed and sub-group analysis of early hormone treated patients was also undertaken. Chromogranin-A expression correlated with high Gleason score (χ(2) = 28.35, p < 0.001) and early prostate cancer death (HR = 1.61, 95 %CI = 1.15-2.27, p < 0.001). In univariate analysis, NE differentiation correlated significantly with outcome (HR = 1.61, 95 % CI 1.15-2.27, p < 0.001) However in multivariate analysis including Gleason score, chromogranin-A expression was not an independent predictor of survival (HR = 0.97, 95 %CI = 0.89-1.37, p = 0.87). Although chromogranin-A expression was higher in patients with early hormone therapy (χ(2) = 7.25, p = 0.007), there was no association with prostate cancer survival in this sub-group (p = 0.083). Determination of neuroendocrine differentiation does not appear to have any bearing on the outcome of prostatic carcinoma and does not add to the established prognostic model.
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Affiliation(s)
- S S Jeetle
- Department of Molecular Oncology, Barts Cancer Institute, Charterhouse Square, London, EC1M 6BQ, UK
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Toubaji A, Sutcliffe S, Chaux A, Lecksell K, Hicks J, De Marzo AM, Platz EA, Netto GJ. Immunohistochemical expression of minichromosome maintenance complex protein 2 predicts biochemical recurrence in prostate cancer: a tissue microarray and digital imaging analysis-based study of 428 cases. Hum Pathol 2012; 43:1852-65. [PMID: 22554381 DOI: 10.1016/j.humpath.2012.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 01/09/2012] [Accepted: 01/11/2012] [Indexed: 12/01/2022]
Abstract
Prostate cancer remains a major health problem in the United States. Established clinicopathologic parameters such as Gleason score, T stage, and prostate-specific antigen levels are currently the guiding tools for prognostication and disease management. The addition of biomarkers could increase the accuracy of these parameters for predicting disease progression, response to therapy, and survival. In this regard, the goal of this study was to evaluate minichromosome maintenance complex protein 2 and Ki-67 immunohistochemical expression as predictors of outcome in prostate cancer. For this purpose, 11 tissue microarrays were constructed using tumor and nontumor samples from 428 patients. Patients were divided into short-term (mean, 2.9 years) and long-term (mean, 14.1 years) follow-up groups. End points were biochemical recurrence for the short-term follow-up group and prostate cancer-related death for the long-term follow-up group. All men in the long-term follow-up group had biochemical recurrence at the time of recruitment. Expression of both markers was higher in tumor than in nontumor glands. Percentage of minichromosome maintenance complex protein 2 was associated with Gleason score in both groups. Percentage of Ki-67 was associated with Gleason score and pathologic stage only in the short-term follow-up group. Higher minichromosome maintenance complex protein 2 percentages were associated with biochemical recurrence in the short-term follow-up group. In the long-term follow-up group, neither minichromosome maintenance complex protein 2 nor Ki-67 levels predicted prostate cancer death. In conclusion, our results suggest that in patients treated by radical prostatectomy for clinically localized prostate cancer, immunohistochemistry for minichromosome maintenance complex protein 2 expression could be used to predict biochemical recurrence, independent of other known clinicopathologic factors.
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Affiliation(s)
- Antoun Toubaji
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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27
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Sagnak L, Topaloglu H, Ozok U, Ersoy H. Prognostic significance of neuroendocrine differentiation in prostate adenocarcinoma. Clin Genitourin Cancer 2012; 9:73-80. [PMID: 22035833 DOI: 10.1016/j.clgc.2011.07.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Revised: 07/20/2011] [Accepted: 07/27/2011] [Indexed: 01/04/2023]
Abstract
Much progress has been made toward an understanding of the development and progression of prostate cancer (PC) and the factors that drive the development of androgen independence. Neuroendocrine (NE) cells may provide an intriguing link between NE cell differentiation (NED) and tumor progression in PC. NED in PC generally confers a more aggressive clinical behavior and less favorable prognosis than conventional PC. In this article, we review the known functions of NE cells in PC and discuss the current knowledge on stimulation of cancer proliferation, invasion, apoptosis resistance, serum and immunohistochemical markers, and the prognostic significance of NED in human PC.
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Affiliation(s)
- Levent Sagnak
- Ministry of Health, Diskapi Yildirim Beyazit Education and Research Hospital, 3rd Urology Clinic, Ankara, Turkey.
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Kakies C, Hakenberg OW, Gunia S, Erbersdobler A. Prostate cancer with Paneth cell-like neuroendocrine differentiation and extensive perineural invasion: coincidence or causal relationship? Pathol Res Pract 2011; 207:715-7. [PMID: 21924841 DOI: 10.1016/j.prp.2011.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 08/05/2011] [Indexed: 01/06/2023]
Abstract
The case of a 74-year-old man is reported who suffered from a locally advanced prostate cancer treated by neoadjuvant hormonal ablation, followed by prostatectomy. Histological examination of the prostatectomy specimen disclosed an adenocarcinoma with partial, Paneth-like, neuroendocrine differentiation. Extensive perineural tumor invasion was found with a total of 921 perineural tumor foci. Neuroendocrine differentiation of tumor cells was accentuated in perineural locations and was associated with an elevated expression of N-CAM and vimentin, and a reduced expression of E-Cadherin and Ki-67. We hypothesize that neuroendocrine differentiation may promote perineural invasion of prostate cancer cells by a "catherin-switch" and by mechanisms involving epithelial-mesenchymal transition.
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Tomaszewski JJ, Cummings JL, Parwani A, Dhir R, Mason JB, Nelson JB, Bacich DJ, O’Keefe DS. Increased cancer cell proliferation in prostate cancer patients with high levels of serum folate. Prostate 2011; 71:1287-93. [PMID: 21308713 PMCID: PMC3120927 DOI: 10.1002/pros.21346] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 12/28/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND A recent clinical trial revealed that folic acid supplementation is associated with an increased incidence of prostate cancer (Figueiredo et al., J Natl Cancer Inst 2009; 101(6): 432-435). As tumor cells in culture proliferate directly in response to available folic acid, the goal of our study was to determine if there is a similar relationship between patient folate status, and the proliferative capacity of tumors in men with prostate cancer. METHODS Serum folate and/or prostate tissue folate was determined in 87 randomly selected patients undergoing surgery for prostate cancer, and compared to tumor proliferation in a subset. RESULTS Fasting serum folate levels were positively correlated with prostate tumor tissue folate content (n = 15; r = 0.577, P < 0.03). Mean serum folate was 62.6 nM (7.5-145.2 nM), 39.5% of patients used supplements containing folic acid (n = 86). The top quartile of patients had serum folates above 82 nM, six times the level considered adequate. Of these, 48% reported no supplement use. Among 50 patients with Gleason 7 disease, the mean proliferation index as determined by Ki67 staining was 6.17 ± 3.2% and 0.86 ± 0.92% in the tumors from patients in the highest (117 ± 15 nM) and lowest (18 ± 9 nM) quintiles for serum folate, respectively (P < 0.0001). CONCLUSIONS Increased cancer cell proliferation in men with higher serum folate concentrations is consistent with an increase in prostate cancer incidence observed with folate supplementation. Unexpectedly, more than 25% of patients had serum folate levels greater than sixfold adequate. Nearly half of these men reported no supplement use, suggesting either altered folate metabolism and/or sustained consumption of folic acid from fortified foods.
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Affiliation(s)
- Jeffrey J. Tomaszewski
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, U.S.A
| | - Jessica L. Cummings
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, U.S.A
| | - Anil Parwani
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, U.S.A
| | - Rajiv Dhir
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, U.S.A
| | - Joel B. Mason
- Jean Mayer U.S. Department of Agriculture, Human Nutrition Research Center on Aging at Tufts University, Boston, MA, U.S.A
| | - Joel B. Nelson
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, U.S.A
| | - Dean J. Bacich
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, U.S.A
| | - Denise S. O’Keefe
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, U.S.A
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Malhotra S, Lapointe J, Salari K, Higgins JP, Ferrari M, Montgomery K, van de Rijn M, Brooks JD, Pollack JR. A tri-marker proliferation index predicts biochemical recurrence after surgery for prostate cancer. PLoS One 2011; 6:e20293. [PMID: 21629784 PMCID: PMC3100337 DOI: 10.1371/journal.pone.0020293] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 04/28/2011] [Indexed: 12/20/2022] Open
Abstract
Prostate cancer exhibits tremendous variability in clinical behavior, ranging
from indolent to lethal disease. Better prognostic markers are needed to
stratify patients for appropriately aggressive therapy. By expression profiling,
we can identify a proliferation signature variably expressed in prostate
cancers. Here, we asked whether one or more tissue biomarkers might capture that
information, and provide prognostic utility. We assayed three proliferation
signature genes: MKI67 (Ki-67; also a classic proliferation
biomarker), TOP2A (DNA topoisomerase II, alpha), and
E2F1 (E2F transcription factor 1). Immunohistochemical
staining was evaluable on 139 radical prostatectomy cases (in tissue microarray
format), with a median clinical follow-up of eight years. Each of the three
proliferation markers was by itself prognostic. Notably, combining the three
markers together as a “proliferation index” (0 or 1,
vs. 2 or 3 positive markers) provided superior prognostic
performance (hazard ratio = 2.6 (95% CI:
1.4–4.9); P = 0.001). In a
multivariate analysis that included preoperative serum prostate specific antigen
(PSA) levels, Gleason grade and pathologic tumor stage, the composite
proliferation index remained a significant predictor
(P = 0.005). Analysis of
receiver-operating characteristic (ROC) curves confirmed the improved
prognostication afforded by incorporating the proliferation index (compared to
the clinicopathologic data alone). Our findings highlight the potential value of
a multi-gene signature-based diagnostic, and define a tri-marker proliferation
index with possible utility for improved prognostication and treatment
stratification in prostate cancer.
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Affiliation(s)
- Sameer Malhotra
- Department of Urology, Stanford University, Stanford, California, United
States of America
| | - Jacques Lapointe
- Department of Surgery, Urology Division, McGill University, Montreal,
Quebec, Canada
| | - Keyan Salari
- Department of Pathology, Stanford University, Stanford, California,
United States of America
- Department of Genetics, Stanford University, Stanford, California, United
States of America
| | - John P. Higgins
- Department of Pathology, Stanford University, Stanford, California,
United States of America
| | - Michelle Ferrari
- Department of Urology, Stanford University, Stanford, California, United
States of America
| | - Kelli Montgomery
- Department of Pathology, Stanford University, Stanford, California,
United States of America
| | - Matt van de Rijn
- Department of Pathology, Stanford University, Stanford, California,
United States of America
| | - James D. Brooks
- Department of Urology, Stanford University, Stanford, California, United
States of America
- * E-mail: (JDB); (JRP)
| | - Jonathan R. Pollack
- Department of Pathology, Stanford University, Stanford, California,
United States of America
- * E-mail: (JDB); (JRP)
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Tolonen TT, Tammela TL, Kujala PM, Tuominen VJ, Isola JJ, Visakorpi T. Histopathological variables and biomarkers enhancer of zeste homologue 2, Ki-67 and minichromosome maintenance protein 7 as prognosticators in primarily endocrine-treated prostate cancer. BJU Int 2011; 108:1430-8. [DOI: 10.1111/j.1464-410x.2011.10253.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Ito Y, Miyauchi A, Kakudo K, Hirokawa M, Kobayashi K, Miya A. Prognostic significance of ki-67 labeling index in papillary thyroid carcinoma. World J Surg 2011; 34:3015-21. [PMID: 20703465 DOI: 10.1007/s00268-010-0746-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Ki-67 is a useful tool for evaluating cell proliferative activity in various tumors. Although the utility of Ki-67 labeling index (LI) to diagnose thyroid neoplasms has been investigated, little is known regarding the relationship between Ki-67 LI and the biological behavior of papillary thyroid carcinoma. In this study, we examined Ki-67 in 371 patients with papillary thyroid carcinoma to elucidate this issue. METHODS A total of 371 patients with papillary carcinoma who underwent initial and locally curative surgery between 1996 and 1997 were enrolled in this study. We immunohistochemically investigated Ki-67 LI in their primary lesions and compared this finding with various clinicopathological features, including patient prognosis. RESULTS Ki-67 LI was ≤1% in 213 patients (57%) and among the remaining 158, 35 showed Ki-67 LI >3%. Ki-67 LI was associated with patient age, massive extrathyroid extension, and distant metastasis at surgery. Of 363 patients without distant metastasis at surgery, 54 (15%) showed carcinoma recurrence during follow-up (average 124 months) and the disease-free survival (DFS) of patients with Ki-67 LI >1% was significantly worse than that of those with Ki-67 LI <1% (p < 0.0001). On multivariate analysis, Ki-67 LI was recognized as an independent prognostic factor for the DFS of patients. Although only eight patients died of carcinoma in our series, patients with Ki-67 LI >3% showed a significantly worse cause-specific survival (CSS) than those with Ki-67 LI <3% (p < 0.0001). CONCLUSIONS Careful evaluation of Ki-67 LI in primary lesions can predict DFS and CSS of patients with papillary thyroid carcinoma.
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Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, 8-2-35, Shimoyamate-dori, Chuo-ku, Kobe City, 650-0011, Japan.
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Berruti A, Vignani F, Russo L, Bertaglia V, Tullio M, Tucci M, Poggio M, Dogliotti L. Prognostic role of neuroendocrine differentiation in prostate cancer, putting together the pieces of the puzzle. Res Rep Urol 2010; 2:109-24. [PMID: 24198620 PMCID: PMC3818883 DOI: 10.2147/rru.s6573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Neuroendocrine (NE) differentiation is a common feature in prostate cancer (PC). The clinical significance of this phenomenon is controversial; however preclinical and clinical data are in favor of an association with poor prognosis and early onset of a castrate resistant status. NE PC cells do not proliferate, but they can stimulate the proliferation of the exocrine component through the production of paracrine growth factors. The same paracrine signals may favor the outgrowth of castrate adapted tumors through androgen receptor dependent or independent mechanisms. Noteworthy, NE differentiation in PC is not a stable phenotype, being stimulated by several agents including androgen deprivation therapy, radiation therapy, and chemotherapy. The proportion of NE positive PC, therefore, is destined to increase during the natural history of the disease. This may complicate the assessment of the prognostic significance of this phenomenon. The majority of clinical studies have shown a significant correlation between NE differentiation and disease prognosis, confirming the preclinical rationale. In conclusion the NE phenotype is a prognostic parameter in PC. Whether this phenomenon is a pure prognostic factor or whether it can influence the prognosis by favoring the onset of a castrate resistance status is a matter of future research.
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Affiliation(s)
- Alfredo Berruti
- Oncologia Medica, Università di Torino, Azienda Ospedaliero Universitaria San Luigi, Orbassano, Italy
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Zellweger T, Günther S, Zlobec I, Savic S, Sauter G, Moch H, Mattarelli G, Eichenberger T, Curschellas E, Rüfenacht H, Bachmann A, Gasser TC, Mihatsch MJ, Bubendorf L. Tumour growth fraction measured by immunohistochemical staining of Ki67 is an independent prognostic factor in preoperative prostate biopsies with small-volume or low-grade prostate cancer. Int J Cancer 2009; 124:2116-23. [PMID: 19117060 DOI: 10.1002/ijc.24174] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Accurate prognostic parameters in prostate biopsies are needed to better counsel individual patients with prostate cancer. We evaluated the prognostic impact of morphologic and immunohistochemical parameters in preoperative prostate cancer biopsies. A consecutive series of prostate biopsies of 279 men (72% with clinical stage T1c and 23% with T2) who subsequently underwent radical prostatectomy was prospectively analysed for Gleason score, number and percentage of positive cores (NPC, PPC), total percentage of biopsy tissue with tumour (TPT), maximum tumour percentage per core (MTP), and expression of Ki67, Bcl-2 and p53. All biopsy features were significantly associated with at least one feature of the radical prostatectomy specimen. pT stage was independently predicted by PSA, seminal vesicle invasion by Ki67 LI, positive margins by PSA and MTP, large tumour diameter by PSA and PPC, and Gleason score by biopsy Gleason score, MTP, and Ki67 LI, respectively. Biopsy Gleason score, NPC (1 vs. >1), TPT (<7 vs. >or=7%), and Ki67 LI (<10 vs. >or=10%) were significant predictors of biochemical recurrence after radical prostatectomy (p < 0.01, each). KI67 LI was the only independent prognostic factor in case of a low TPT (<7%) or low Gleason score (<7), the hazard ratio being 6.76 and 6.44, respectively. In summary, preoperative Gleason score, NPC, TPT and Ki67 LI significantly predict the risk of recurrence after radical prostatectomy, and Ki67 is an independent prognosticator in biopsies with low-volume or low-grade prostate cancer. Analysis of Ki67 LI in these biopsies may help to better identify patients with clinically insignificant prostate cancer.
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Jungwirth N, Haeberle L, Schrott KM, Wullich B, Krause FS. Serotonin used as prognostic marker of urological tumors. World J Urol 2008; 26:499-504. [PMID: 18581119 DOI: 10.1007/s00345-008-0285-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 05/23/2008] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In regard to therapy and prognosis of urological tumors, specific tumor markers are lacking especially in renal and urinary bladder carcinoma. Our study examines the relevance of serum serotonin levels to urinary bladder, prostate, renal, and testicular carcinoma when it comes to prognosis and occurrence of these oncological conditions. MATERIALS AND METHODS Serotonin levels were obtained in 109 patients presenting with urothelial carcinoma to the urinary bladder, adenocarcinoma of the prostate and renal cell carcinoma, as well as presenting with seminomatous and non-seminomatous testicular tumors. All of these conditions varied in grades and metastases. Serum levels were drawn between 7 and 8 a.m. exclusively in order to avoid circadian changes. RESULTS Serotonin levels in urothelial carcinoma appeared within pathological range in correlation with tumor stage, life expectancy, and statistical significant with distant metastases. In prostate carcinoma, serotonin levels showed a tendency with organ exceeding growth, Grading/Gleason Score, PSA values >100 ng/ml, and the presence of distant metastases. In renal cell carcinoma, serotonin levels were decreased in patients with lymph node and distant metastases; there was no significant correlation with extent of infiltration. In regard to testicular carcinoma, decreased serotonin levels were merely noted in mixed tumors and the one extragonadal seminoma. Otherwise there was no correlation observed with stage and grade as well as with common tumor markers (AFP/betaHCG). CONCLUSION Serotonin levels are suitable for prognostic evaluation of urothelial carcinoma in the urinary bladder, adenocarcinoma of the prostate, and renal cell carcinoma, especially taking into account the lab cost of 25<euro> per test.
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Affiliation(s)
- Nina Jungwirth
- Depatment of Urology, University of Erlangen-Nuremberg, Erlangen, Germany
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