Adenocarcinoma on needle prostatic biopsies: Does reactive stroma predicts biochemical recurrence in patients following radical prostatectomy?

Objective There is evidence that reactive stroma in different cancers may regulate tumor progression. The aim of this study is to establish any possible relation of reactive stroma grading on needle prostatic biopsies to biochemical recurrence. Materials and Methods The study group comprised 266 biopsies from consecutive patients submitted to radical prostatectomy. Reactive stroma was defined as stroma surrounding neoplastic tissue and graded as 0 (absent), 1 (slight), 2 (moderate), and 3 (intense) according to tumor stroma area relative to total tumor area. Results From the total of 266 needle prostatic biopsies, 143 (53.8%), 55 (20.7%), 54 (20.3%), and 14 (5.3%) showed grades 0, 1, 2, and 3, respectively. Increasing reactive stroma grade was significantly associated with clinical stage T2, higher preoperative PSA, higher biopsy and radical prostatectomy Gleason score, more extensive tumors in radical prostatectomy, and pathologic stage > T2. Only grade 3 was significantly associated with time and risk to biochemical recurrence. On multivariate analysis only preoperative PSA and 2 methods of biopsy tumor extent evaluation were independent predictors. Conclusion Increasing reactive stroma grade on biopsies is significantly associated with several clinicopathologic adverse findings, however, only grade 3 predicts time and risk to biochemical recurrence following radical prostatectomy on univariate but not on multivariate analysis. We have not been able to show that reactive stroma grade 3 on biopsies is an independent predictor of biochemical recurrence beyond that of preoperative PSA and other pathologic findings on biopsy.

研究目的：已有证据表明，不同癌症中的反应性间质（reactive stroma）可调控肿瘤进展。本研究旨在明确前列腺穿刺活检（needle prostatic biopsies）标本中的反应性间质分级与生化复发（biochemical recurrence）之间的潜在关联。
材料与方法：本研究队列纳入266份来自连续接受根治性前列腺切除术（radical prostatectomy）患者的穿刺活检标本。反应性间质被定义为包裹肿瘤组织的间质，并根据肿瘤间质面积占肿瘤总面积的比例分为0级（无）、1级（轻度）、2级（中度）与3级（重度）。
结果：在全部266份前列腺穿刺活检标本中，分别有143份（53.8%）、55份（20.7%）、54份（20.3%）与14份（5.3%）对应0、1、2、3级反应性间质。反应性间质分级升高与临床T2分期、更高的术前前列腺特异性抗原（Prostate-Specific Antigen, PSA）水平、更高的穿刺活检及根治性前列腺切除术格里森评分（Gleason score）、根治性前列腺切除术标本中肿瘤范围更广以及病理分期＞T2均存在显著关联。仅3级反应性间质与生化复发的发生时间及风险存在显著关联。多变量分析结果显示，仅术前PSA水平与2种穿刺活检肿瘤范围评估方法为独立预测因子。
结论：穿刺活检标本中的反应性间质分级升高与多项临床病理不良特征存在显著关联，但仅3级反应性间质在单变量分析中可预测根治性前列腺切除术后的生化复发时间与风险，而在多变量分析中则无此关联。本研究未能证明，相较于术前PSA水平及穿刺活检的其他病理特征，穿刺活检标本中的3级反应性间质是生化复发的独立预测因子。