Cribriform Tumor Burden in Grade Group 4 Prostate Cancer: A Quantitative Threshold Predicting Lymphovascular Invasion...

Area of Science:

• Urology
• Oncology
• Pathology

Background:

• Cribriform pattern (CP) and its diameter are known prognostic factors in prostate cancer (PCa).
• The clinical impact of quantitative cribriform tumor burden (CTB) is not well understood.
• Large cribriform glands (LC-GG4) represent a specific subtype of Grade Group 4 PCa.

Purpose of the Study:

• To assess the association between CTB and clinicopathological outcomes in LC-GG4.
• To determine if quantitative CTB improves risk stratification compared to binary assessment.
• To identify a CTB threshold predictive of adverse pathological features and disease progression.

Main Methods:

• Retrospective analysis of 43 patients with pure GG4 PCa and ≥1 large cribriform gland (>0.25 mm).
• CTB quantified as the percentage of cribriform architecture relative to total tumor area.
• Receiver operating characteristic (ROC) analysis to determine optimal CTB threshold for lymphovascular invasion (LVI); Kaplan-Meier and log-rank tests for survival analysis (dMFS, BCRFS).

Main Results:

• 100% of patients had extraprostatic extension; median CTB was 30.0%.
• A CTB threshold of ≥25% optimally predicted LVI (AUC: 0.801, p=0.002).
• High CTB (≥25%) correlated with LVI and intraductal carcinoma, and was independently associated with LVI (OR: 1.054, p=0.006); associated with shorter distant metastasis-free survival (dMFS) (84.9 vs. 113.1 months, p=0.042).

Conclusions:

• CTB is a critical determinant of clinical aggressiveness in LC-GG4 PCa.
• A quantitative CTB threshold of ≥25% is independently associated with LVI and early metastatic progression.
• Quantifying CTB offers superior risk stratification for LC-GG4 PCa compared to binary assessment.