Focal Neuroendocrine Differentiation of Conventional Prostate Adenocarcinoma as a Prognostic Factor after Radical Prostatectomy: A Systematic Review and Meta-Analysis.

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.

International journal of molecular sciences. 2019 Mar 19*** epublish ***

Mehdi Kardoust Parizi, Takehiro Iwata, Shoji Kimura, Florian Janisch, Mohammad Abufaraj, Pierre I Karakiewicz, Dmitry Enikeev, Leonid M Rapoport, Georg Hutterer, Shahrokh F Shariat

Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria. ., Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria. ., Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria. ., Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria. ., Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria. ., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC H3h 1s8, Canada. ., Institute for Urology and Reproductive Health, Sechenov University, Moscow 119991, Russia. ., Institute for Urology and Reproductive Health, Sechenov University, Moscow 119991, Russia. ., Department of Urology, Medical University Graz, A-8036 Graz, Austria. ., Institute for Urology and Reproductive Health, Sechenov University, Moscow 119991, Russia. .