Importance and outcome relevance of central pathology review in prostatectomy specimens: data from the SAKK 09/10 randomized trial on prostate cancer.
- Ghadjar P Department of Radiation Oncology, Inselspital, Bern University Hospital, Bern, Switzerland.
- Hayoz S SAKK Coordinating Center, Bern, Switzerland.
- Genitsch V Department of Pathology of the University of Bern, Bern, Switzerland.
- Zwahlen DR Department of Radiation Oncology, Kantonsspital Graubünden, Chur, Switzerland.
- Hölscher T University Hospital Dresden, Dresden, Germany.
- Gut P Kantonsspital Luzern, Luzern, Switzerland.
- Guckenberger M University Hospital Würzburg, Würzburg, Germany.
- Hildebrandt G University Hospital Rostock, Rostock, Germany.
- Müller AC University Hospital Tübingen, Tübingen, Germany.
- Putora PM Kantonsspital St. Gallen, St. Gallen, Switzerland.
- Papachristofilou A University Hospital Basel, Basel, Switzerland.
- Stalder L SAKK Coordinating Center, Bern, Switzerland.
- Biaggi-Rudolf C SAKK Coordinating Center, Bern, Switzerland.
- Sumila M Hirslanden Hospital Group, Zürich, Switzerland.
- Kranzbühler H Stadtspital Triemli, Zürich, Switzerland.
- Najafi Y University Hospital Zürich, Zürich, Switzerland.
- Ost P Ghent University Hospital, Ghent, Belgium.
- Azinwi NC Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland.
- Reuter C Kantonsspital Münsterlingen, Münsterlingen, Switzerland.
- Bodis S Kantonsspital Aarau, Aarau, Switzerland.
- Khanfir K Hôpital Valais, Sion, Switzerland.
- Budach V Charité Universitätsmedizin Berlin, Berlin, Germany.
- Aebersold DM Department of Radiation Oncology, Inselspital, Bern University Hospital, Bern, Switzerland.
- Thalmann GN Department of Urology, Inselspital, Bern University Hospital, Bern, Switzerland.
- 2016-12-18
Published in:
- BJU international. - 2017
#PCSM
#ProstateCancer
central pathology review
radiation
salvage
Aged
Clinical Trials, Phase III as Topic
Humans
Immunohistochemistry
In Situ Hybridization, Fluorescence
Male
Middle Aged
Neoplasm Grading
Neoplasm Recurrence, Local
Predictive Value of Tests
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms
Radiotherapy, Adjuvant
Random Allocation
Randomized Controlled Trials as Topic
Retrospective Studies
Salvage Therapy
Treatment Outcome
English
OBJECTIVE
To conduct a central pathology review within a randomized clinical trial on salvage radiation therapy (RT) in the presence of biochemical recurrence after prostatectomy to assess whether this results in changes in histopathological prognostic factors, such as Gleason score.
PATIENTS AND METHODS
A total of 350 patients were randomized and specimens from 279 patients (80%) were centrally reviewed by a dedicated genitourinary pathologist. Gleason score, tumour classification and resection margin status were reassessed and compared with the results of local pathology review. Agreement was assessed using contingency tables and Cohen's kappa coefficient. The association between other histopathological features (e.g. largest diameter of carcinoma) and rapid biochemical progression (up to 6 months after salvage RT) was also investigated.
RESULTS
There was good concordance between central and local pathology review for seminal vesicle invasion (pT3b: 91%; κ = 0.95 [95% confidence interval {CI} 0.89, 1.00]), extraprostatic extension (pT3a/b: 94%; κ = 0.82 [95% CI 0.75, 0.89]) and positive surgical margin (PSM) status (87%; κ = 0.7 [95% CI 0.62, 0.79]). The rate of agreement was lower for Gleason score (78%; κ = 0.61 [95% CI 0.52, 0.70]). The median (range) largest diameter of carcinoma was 16 (3-38) mm. A total of 49 patients (18%) experienced rapid biochemical progression after salvage RT. Largest diameter of carcinoma (odds ratio [OR] 2.04 [95% CI 1.30, 3.20]; P = 0.002), resection margin status (OR 0.36 [95% CI 0.18, 0.72]; P = 0.004) and Gleason score (OR 1.55 [95% CI 1.00, 2.42]; P = 0.05) remained associated with rapid progression after salvage RT after backward selection.
CONCLUSION
The results of the central pathology analyses showed concordance between central and local pathology review with regard to seminal vesicle invasion, extraprostatic extension and PSM status, but a lower rate of agreement for Gleason score. Largest diameter of carcinoma was found to be a potential prognostic factor for rapid biochemical progression after salvage RT.
To conduct a central pathology review within a randomized clinical trial on salvage radiation therapy (RT) in the presence of biochemical recurrence after prostatectomy to assess whether this results in changes in histopathological prognostic factors, such as Gleason score.
PATIENTS AND METHODS
A total of 350 patients were randomized and specimens from 279 patients (80%) were centrally reviewed by a dedicated genitourinary pathologist. Gleason score, tumour classification and resection margin status were reassessed and compared with the results of local pathology review. Agreement was assessed using contingency tables and Cohen's kappa coefficient. The association between other histopathological features (e.g. largest diameter of carcinoma) and rapid biochemical progression (up to 6 months after salvage RT) was also investigated.
RESULTS
There was good concordance between central and local pathology review for seminal vesicle invasion (pT3b: 91%; κ = 0.95 [95% confidence interval {CI} 0.89, 1.00]), extraprostatic extension (pT3a/b: 94%; κ = 0.82 [95% CI 0.75, 0.89]) and positive surgical margin (PSM) status (87%; κ = 0.7 [95% CI 0.62, 0.79]). The rate of agreement was lower for Gleason score (78%; κ = 0.61 [95% CI 0.52, 0.70]). The median (range) largest diameter of carcinoma was 16 (3-38) mm. A total of 49 patients (18%) experienced rapid biochemical progression after salvage RT. Largest diameter of carcinoma (odds ratio [OR] 2.04 [95% CI 1.30, 3.20]; P = 0.002), resection margin status (OR 0.36 [95% CI 0.18, 0.72]; P = 0.004) and Gleason score (OR 1.55 [95% CI 1.00, 2.42]; P = 0.05) remained associated with rapid progression after salvage RT after backward selection.
CONCLUSION
The results of the central pathology analyses showed concordance between central and local pathology review with regard to seminal vesicle invasion, extraprostatic extension and PSM status, but a lower rate of agreement for Gleason score. Largest diameter of carcinoma was found to be a potential prognostic factor for rapid biochemical progression after salvage RT.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1111/bju.13742
- PMID 27987524
- Persistent URL
- https://sonar.ch/global/documents/150
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