Importance and outcome relevance of central pathology review in prostatectomy specimens: data from the SAKK 09/10 randomized trial on prostate cancer

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 shifts of histopathological prognostic factors such as the Gleason Score.

A total of 350 patients were randomized and specimens of 279 (80%) of the patients were centrally reviewed by a dedicated genitourinary pathologist. The Gleason Score, tumor classification and resection margin status were reassessed and compared with the local pathology reports. Agreement was assessed using contingency tables and Cohen's Kappa. Additionally, the association between other histopathological features (e.g. largest diameter of carcinoma) with rapid biochemical progression (up to 6 months after salvage RT) was investigated.

There was good concordance between central pathology review and local pathologists for seminal vesicle invasion [pT3b: 91%; k=0.95 (95% CI 0.89, 1.00)], for extraprostatic extension [pT3a/b: 94%; k=0.82 (95% CI 0.75, 0.89)], and for positive surgical margin status [87%; k=0.7 (95% CI 0.62, 0.79)]. Agreement was lower for Gleason score [78%; k=0.61 (95% CI 0.52, 0.70)]. The median largest diameter of carcinoma was 16 mm (range, 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% Confidence interval (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.

The results of the central pathology analyses reveal concordant results for seminal vesicle invasion, extraprostatic extension, positive surgical margin but lower agreement for Gleason Score. Largest diameter of carcinoma was found to be a potential prognostic factor for rapid biochemical progression after salvage RT. This article is protected by copyright. All rights reserved.

BJU international. 2016 Dec 17 [Epub ahead of print]

Pirus Ghadjar, Stefanie Hayoz, Vera Genitsch, Daniel R Zwahlen, Tobias Hölscher, Philipp Gut, Matthias Guckenberger, Guido Hildebrandt, Arndt-Christian Müller, Martin P Putora, Alexandros Papachristofilou, Lukas Stalder, Christine Biaggi-Rudolf, Marcin Sumila, Helmut Kranzbühler, Yousef Najafi, Piet Ost, Ngwa C Azinwi, Christiane Reuter, Stephan Bodis, Kaouthar Khanfir, Volker Budach, Daniel M Aebersold, George N Thalmann, Swiss Group for Clinical Cancer Research (SAKK)

Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Switzerland, now at Charité Universitätsmedizin Berlin, Germany., SAKK Coordinating Center, Bern, Switzerland., Department of Pathology of the University of Bern, Switzerland., Departments of Radiation Oncology, Kantonsspital Graubünden, Chur, Switzerland., University Hospital Dresden, Germany., Kantonsspital Luzern, Switzerland, now at Hirslanden Hospital Group, Zürich, Switzerland., University Hospital Würzburg, Germany, now at University Hospital Zürich, Switzerland., University Hospital Rostock, Germany., University Hospital Tübingen, Germany., Kantonsspital St. Gallen, Switzerland., University Hospital Basel, Switzerland., SAKK Coordinating Center, Bern, Switzerland, now at University of Bern, Switzerland., Hirslanden Hospital Group, Zürich, Switzerland., Stadtspital Triemli, Zürich, Switzerland., University Hospital Zürich, Switzerland., Ghent University Hospital, Belgium., Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland., Kantonsspital Münsterlingen, Switzerland., Kantonsspital Aarau, Switzerland., Hôpital Valais, Sion, Switzerland., Charité Universitätsmedizin Berlin, Germany., Inselspital, Bern University Hospital, Switzerland., Department of Urology, Inselspital, Bern University Hospital, Switzerland.