Microvascular invasion of the seminal vesicles in adenocarcinoma of the prostate

The objective of this article is to determine the relationship between microvascular invasion and seminal vesicle invasion in prostatic adenocarcinoma. Radical prostatectomies with seminal vesicle involvement were examined histologically and immunohistochemically with antibodies directed against S-100 protein and factor VIII. Microvascular invasion of the seminal vesicles showed a positive correlation with microvascular and capsular invasion of the prostate (P = 0.006 and 0.048, respectively) and lymph node metastases. Tumor progression was found in 8 of 14 (57%) patients with microvascular invasion of the seminal vesicles, compared with 3 of 22 (14%) without microvascular invasion (P = 0.001). Microvascular invasion of the seminal vesicles is predictive of tumor progression and lymph node metastases in prostatic adenocarcinoma. © 1996 Wiley-Liss, Inc.     

前哨淋巴结阳性乳腺癌非前哨淋巴结转移的情况分析

目的探讨前哨淋巴结（SLN）阳性乳腺癌患者的临床病理特征与非前哨淋巴结（NSLN）转移的关系。 方法回顾性分析2010年1月至2016年1月中山大学附属第一医院500例行前哨淋巴结活检（SLNB）的临床分期为T_1-2N₀M₀期乳腺癌患者资料,其中病理检查确诊SLN阳性、随后行腋窝淋巴结清扫（ALND）的乳腺癌患者共89例,总结其临床、病理因素的特征及其对腋窝NSLN转移的影响因素进行单因素及多因素Logistic分析。 结果SLN阳性率为17.8%（89/500）,49.4%（44/89）出现NSLN转移。单因素分析显示,NSLN转移与原发肿瘤分期、脉管浸润、SLN阳性数、SLN阳性率相关（χ²=4.062、36.084、7.003、10.889,P=0.044、<0.001、0.030、0.004）。进一步多因素Logistic回归分析显示,脉管浸润、SLN阳性率是NSLN转移的独立预测因子（OR=46.142,95%CI：11.821~258.472,P<0.000 1;OR=10.482,95%CI：2.564~51.312,P=0.002）。 结论SLN阳性的乳腺癌患者,其原发肿瘤分期、肿瘤是否多发、脉管浸润、SLN阳性数、SLN转移率与腋窝NSLN转移相关。其中,脉管浸润及SLN阳性率≥0.5是SLN阳性乳腺癌患者腋窝NSLN转移的独立预测因子。     

The presence of extracapsular extension is associated with an increased risk of death from prostate cancer after radical prostatectomy for patients with seminal vesicle invasion and negative lymph nodes

ObjectivesDetermining clinicopathologic features that stratify the risk of disease progression in patients with seminal vesicle invasion at radical prostatectomy remains critical for patient counseling, clinical trial enrollment, and the judicious application of secondary therapies. Then, we evaluated the prognostic significance of concomitant extracapsular extension (ECE) in patients with seminal vesicle invasion and negative lymph nodes at radical prostatectomy.MethodsWe identified 1,132 patients who underwent prostatectomy between 1987 and 2009 and were found to have pT3bN0 disease. Median postoperative follow-up was 10.6 years (interquartile range, 5.9–15.3). Survival was estimated using the Kaplan-Meier method and compared for patients with and without ECE with the log-rank test. The association of ECE with outcome was evaluated using Cox proportional hazards regression models.ResultsA total of 693 (61%) patients were noted to have ECE. Compared with pT3bN0 patients without ECE, patients with pT3bN0 tumors and ECE had a significantly worse 15-year biochemical recurrence-free survival (29% vs. 39%; P<0.001), systemic progression-free survival (71% vs. 81%; P<0.001), cancer-specific survival (80% vs. 89%; P<0.001), and overall survival (50% vs. 63%; P<0.001). On multivariate analysis, the presence of ECE was associated with significantly increased risks of systemic progression (hazard ratio [HR], 1.56; P=0.006), death from prostate cancer (HR, 1.71; P=0.01), and all-cause mortality (HR, 1.35; P=0.007). Meanwhile, adjuvant hormonal therapy, which was received by 334 patients (29.5%), was associated with significantly decreased risks of systemic progression (HR, 0.50; P=0.0004) and cancer death (HR, 0.57; P=0.03), but not all-cause mortality (HR, 0.81; P=0.09). Limitations included retrospective design and nonstandardized application of secondary treatments.ConclusionsThe presence of ECE in patients with pT3bN0 prostate cancer is associated with increased risks of systemic progression and cancer death. Pending validation, ECE may be incorporated into risk stratification or staging classification or both. Meanwhile, these patients continue to represent ideal candidates for adjuvant therapy trials.     

Prediction of prostate cancer risk: the role of prostate volume and digital rectal examination in the ERSPC risk calculators

Background

The European Randomized Study of Screening for Prostate Cancer (ERSPC) risk calculators (RCs) are validated tools for prostate cancer (PCa) risk assessment and include prostate volume (PV) data from transrectal ultrasound (TRUS).

Objective

Develop and validate an RC based on digital rectal examination (DRE) that circumvents the need for TRUS but still includes information on PV.

Design, setting, and participants

For development of the DRE-based RC, we studied the original ERSPC Rotterdam RC population including 3624 men (885 PCa cases) and 2896 men (547 PCa cases) detected at first and repeat screening 4 yr later, respectively. A validation cohort consisted of 322 men, screened in 2010-2011 as participants in ERSPC Rotterdam.

Measurements

Data on TRUS-assessed PV in the development cohorts were re-coded into three categories (25, 40, and 60 cm³) to assess the loss of information by categorization of volume information. New RCs including PSA, DRE, and PV categories (DRE-based RC) were developed for men with and without a previous negative biopsy to predict overall and clinically significant PCa (high-grade [HG] PCa) defined as T stage >T2b and/or Gleason score ≥7. Predictive accuracy was quantified by the area under the receiver operating curve. We compared performance with the Prostate Cancer Prevention Trial (PCPT) RC in the validation study.

Results and limitations

Areas under the curve (AUC) of prostate-specific antigen (PSA) alone, PSA and DRE, the DRE-based RC, and the original ERSPC RC to predict PCa at initial biopsy were 0.69, 0.73, 0.77, and 0.79, respectively. The corresponding AUCs for predicting HG PCa were higher (0.74, 0.82, 0.85, and 0.86). Similar results were seen in men previously biopsied and in the validation cohort. The DRE-based RC outperformed the PCPT RC (AUC 0.69 vs 0.59; p = 0.0001) and a model based on PSA and DRE only (AUC 0.69 vs 0.63; p = 0.0075) in the relatively small validation cohort. Further validation is required.

Conclusions

An RC should contain volume estimates based either on TRUS or DRE. Replacing TRUS measurements by DRE estimates may enhance implementation in the daily practice of urologists and general practitioners.     

Evaluation of lymph node metastasis in patients with gastric cancer: a comparison of the directionality of lymph node metastasis and the total number of metastatic lymph nodes

Purpose

The clinical impact of the directionality of lymph node (LN) metastasis was assessed in comparison with the staging by the Japanese Classification of Gastric Carcinoma (JCGC), a numerical LN staging system.

Methods

Two hundred forty-one gastric cancer patients who were diagnosed pathologically to have LN metastasis, and 54 patients who underwent preoperative multidetector-row computed tomography (MDCT) with an image thickness of 1 mm were classified into three groups (unidirectional [Uni-], bidirectional [Bi-], and tridirectional [Tri-] groups) depending on the directionality of their LN metastasis.

Results

The prognosis of the Uni-group was better than that of the Bi- or the Tri-group when assessed on the basis of the pathological findings of metastatic LN and also the preoperative MDCT findings. The exact preoperative evaluation was 70.2 % for the directionality system and 61.7 % for the JCGC system, respectively. The stages were less frequently underestimated by the directionality system than the JCGC system (P < 0.02, 19.1 vs. 34.0 %), and the staging could be more precisely performed by both systems in combination.

Conclusions

More precise preoperative evaluation of disease stage could be obtained by the directionality system and the JCGC system in combination.     

Metabolism of testosterone in the human prostate and seminal vesicles

Tissue from the normal, hyperplastic and the cancerous human prostate as well as tissue from the human seminal vesicles are capable of metabolizing testosterone in vitro. By incubating minced tissue with 3H-testosterone for 2 hours at 37 degrees C the following radioactive metabolites were identified: testosterone (17 beta-hydroxyl-4-androsten-3-one), androstenedione (4-androstene-3,17-dione), androstanedione (5alpha-androstane-3,17-dione), 5alpha-dihydrostestosterone (17 beta-hydroxy-5alpha-androstane-3-one, DHT), 3alpha-androstanediol (5alpha-androstane-3alpha,17beta-diol), 3beta-androstanediol (5alpha-androstane-3beta-17beta-diol) and androsterone (3alpha-hydroxy-5alpha-androstane-17-one). When normal human prostatic tissue was incubated with 3H-testosterone approximately 40% of the hormone was metabolized and 30-35% of the metabolites were identified as DHT. There were apparently no differences in testosterone metabolism between the dorsal and lateral prostatic lobes. A much lower conversion of 3H-testosterone was observed in the seminal vesicles (24%). The same metabolites were formed by prostatic carcinoma tissue, although distinctive quantitative differences from the normal prostate were observed. Thus, only 23% of the testosterone was metabolized by cancerous tissue of which 15% was present as DHT. The formation of 17-keto metabolites and androstanediols in the prostatic carcinoma tissue was approximately the same as in the normal prostatic tissue. The most extensive metabolism of testosterone was found by incubation of tissue from benign nodular prostatic hyperplasia. About 65% of the testosterone was metabolized, and 40% of the metabolites were identified as DHT. Hyperplastic prostatic tissue also showed a significantly higher formation of 5alpha-androstanedoils and the other tissues examined. The high formation of DHT and 5alpha-androstanediols in benign nodular prostatic hyperplasia in comparison with normal and cancerous prostatic tissue and seminal vesicle tissue might indicate that these metabolites should be studied more closely as possible aetiological factors for prostatic hyperplasia. The very low metabolism of testosterone in prostatic carcinoma tissue should be examined further in relation to tumour differentiation and clinical effect of endocrine therapy.     

A preoperative nomogram identifying decreased risk of positive pelvic lymph nodes in patients with prostate cancer

PURPOSE: We developed a preoperative nomogram for prediction of lymph node metastases in patients with clinically localized prostate cancer. MATERIALS AND METHODS: The study was a retrospective, nonrandomized analysis of 7,014 patients treated with radical prostatectomy at 6 institutions between 1985 and 2000. Exclusion criteria consisted of preoperative androgen ablation therapy, salvage radical prostatectomy and pretreatment prostate specific antigen (PSA) greater than 50 ng/ml. Preoperative predictors of lymph node metastases consisted of pretreatment PSA, clinical stage (1992 TNM) and biopsy Gleason sum. These predictors were used in logistic regression analysis based nomograms to predict the probability of lymph node metastases. RESULTS: Overall 5,510 patients with complete clinical and pathological information were included in the study. Lymph nodes metastases were present in 206 patients (3.7%). Pretreatment PSA, biopsy Gleason sum, clinical stage and institution represented predictors of lymph node status (p <0.001). Bootstrap corrected predictive accuracy of the 3-variable nomogram (clinical stage, Gleason sum and PSA) was 0.76. Inclusion of a fourth variable, which accounts for institutional differences in lymph node metastases, yielded an area under the receiver operating characteristics curve of 0.78. The negative predictive value of our nomograms was 0.99 when they predicted 3% or less chance of positive lymph nodes. CONCLUSIONS: Using clinical information, we produced 2 calibrated and validated nomograms, which accurately predict pathologically negative lymph nodes in men with localized prostate cancer who are candidates for radical prostatectomy.     

Corpus cavernosum invasion and tumor grade in the prediction of lymph node condition in penile carcinoma.

Of the 101 patients with penile cancer, we have analyzed 66 from whom we had enough information: 42 (63.3%) patients with corpora cavernosa invasion (T2-3) and 24 (36.6%) without (T1). With respect to the tumor grade, in 36 (54.3%) patients it was well differentiated (G I), in 23 (34.8%) moderately (G II) and in 7 (10.6%) poorly differentiated (G III). We also analyzed the inguinal lymph node condition. Of the 66 patients, 28 (42.4%) developed nodal metastases, and 38 (57.6%) were considered free of nodal metastases and disease with an average follow-up of 76.2 months (range 38-192). The presence of metastatic nodes was influenced by both tumor stage and grade with significant differences between T2-3 and T1 (p = 0.001) and between G II-III and G I (p < 0.01), but each of them alone was not a sufficiently reliable predictive factor. In order to associate local stages and tumor grades in relation to the presence of metastatic nodes, we checked that none of the patients with T1, G I (group 1) developed nodal metastases, and therefore, 'wait and see' should be the suitable approach. Twenty (80%) of the patients with T2-3, G II-III (group 2) developed metastatic lymph nodes, thus, in this group, an early lymphadenectomy should be performed. In the remaining 22 patients with T1, G II-III and T2, G I (group 3), 8 (36.4%) showed metastatic lymph nodes; in this group, other factors such as age, cultural level and obesity should be taken into account when deciding on lymphadenectomy.     

Patterns of internal echoes in lymph nodes in the diagnosis of lung cancer metastasis

In 1989–90, all 37 lung cancer patients scheduled for surgery underwent transesophageal endoscopic ultrasonography (EUS) for pre-operative detection of hilar and mediastinal lymph node metastases. An electronic ultrasonic fiberscope with a linear array (EPB-503-FS, Machida-Toshiba) was used. Of 380 nodes surgically removed and that could have been detected by EUS, the detection rates for histologically metastatic and non-metastatic nodes were 65% (33 of 51) and 44% (144 of 329), respectively (p<0.01). Metastatic nodes were detected readily in every lymph node site, especially subaortic and subcarinal. Non-metastatic nodes were detected at low rates, especially in the superior mediastinum, paratracheal, and tracheobronchial locations. For greater long or short axes of the detected nodes, or for rounder nodes, the metastasis rate was higher. Detected nodes were classified into six types by their internal echo patterns; three were rarely metastatic (called negative) and the other three were often metastatic (called positive). Of the negative nodes histologically proved to be metastatic, metastasis was often diffuse. The positive nodes found to be metastatic tended to have one of two patterns of internal echoes when invasion was diffuse and a third pattern when it was localized. In an examination of the diagnostic usefulness of EUS, we made more correct diagnoses from the internal echo pattern than by reference to either the long or short axis alone. The short axes, node shape, and internal echoes were examined by Hayashi's second method of quantification. The sensitivity, specificity, and accuracy of the diagnoses were 85%, 84%, and 84%, respectively, superior to those by computed tomography done of the same patients.

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Resumen En el período 1989–90 se realizó ultrasonografía endoscópica transesofágica (UET) en la totalidad de los pacientes programados para cirugía por cáncer pulmonar con el propósito de indentificar metástasis ganglíonares biliares y mediastinales, mediante un fibroscopio ultrasónico Machida — Toshiba EPB-503-FS. La tasa de detección para ganglios histológicamente metastásicos en los 380 ganglios resecados y que hybieran podido ser identificados mediante UET fue de 65% (33/51) y 44% (144/329), respectivamente (p<0.01). Los ganglios afectados pudieron ser fácilmente detectados en cada región ganglionar, especialmente en las ubicaciones 1, 2 y 4. La tasa de metástasis apareción incrementada en los ganglios de más largo eje longitudinal o transverso, o aquellos de estructura más redonda. Los ganglios así detectados fueron clasificados en seis tipos según sus patrones ecogénicos internos; tres tipos son raramente metastásicos (denominados negativos) y los otros tres con frecuencia son metastásicos (denominados positivos). En los ganglios negativos que histologicamente resultaron metastásicos, la metastásis generalmente fue del tipo difuso. Los ganglios positivos que demostraron ser matastásicos exhibieron tendencia hacía uno de dos patrones de ecogenicidad interna cuando la invasión era difusa y un tercer patrón cuando la invasión era localizada. Al analizar la utilidad diagnóstica de la UET, encontramos que el diagóstico correcto se derivó más a partir del patrón ecogénico interno que en relación a los ejes longitudinal y tranverso. Los ejes transversos, la forma del ganglio y los ecos internos fueron sujetos al segundo método de Hayashi de cuantificación. La sensibilidad, especificidad y certeza de los diagnósticos fue 85%, 84% y 84% respectivamente, lo cual es superior a lo que se logra mediante la tomografía computadorizada.

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Résumé Pendant la période 1989/90, afin de déterminer l'existence de métastases ganglionnaires hilaires et/ou médiastinales, un examen échographique par voie endoscopique transesophagienne (EE) a été réalisé chez 37 patients consécutifs prévus pour une exérèse chirurgicale d'un cancer du poumon. On a utilisé un fibroscope électronique à ultrasons avec une sonde linéaire (EPB-503-FS). Des 380 ganglions lymphatiques vus en échographie et retirés chirurgicalement, une métastase a été diagnostiquée échographiquement dan 33 et confirmée histologiquement dans 51 cas (33/51=44%), alors que 144 des 329 ganglions indemnes de métastase étaient considérés comme tels par l'échographie (144/329=66%). L'échographie a pu détecter les métastases dans tous les groupes lymphatiques possibles, surtout dans les sites 5 et 7. L'échographie a pu innocenter très peu de ganglions, surtout dans les groupes 1, 2 et 4. Les métastases étaient plus fréquentes lorsque les ganglions étaient ronds et lorsque leurs axes principaux (vertical et horizontal) étaient allongés. On a classé les ganglions en six types selon leur échogénécité: trois étaient rarement métastatiques (appelés négatifs) et trois étaient souvent métastatiques (appelés positifs). Parmi les ganglions dits negatifs qui se sont avérés histologiquement métastaiques, la métastase était souvent diffuse. Lorsqu'un ganglion dit positif était réellement métastatique, l'invasion était diffuse dans deux types sur trois alors que c'était le troisème type d'échogénécité qui avait été observé lorsque l'invasion était localisée. En analyse finale, on a trouvé que la détermination du type d'échogénécité interne a été plus performante pour faire le diagnostic correct que l'augmentation de la taille des ganglions. Le plus petit axe des ganglions, la forme du ganglion et l'échogénécité interne ont été analysés selon la deuxième méthode de qunatification de Hayashi. La sensibilité, la spécificité, et la précision diagnostiques étaient respectivement de 85%, 84% et 84%, c'est à dire des chiffres supérieurs aux résultats obtenus pour la tomodensitométrie.

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Presented at the Société Internationale de Chirurgie, Stockholm, Sweden, August, 1991.