- 研究比较了伴实性 IDC-P 的 28 例患者与不伴实性 IDC-P 的 87 例患者，排除了 IDC-P 内出现粉刺样坏死的病例。
- 实性 IDC-P 与较差的无生化复发生存和肿瘤特异性生存相关；多变量分析中仍能独立预测术后复发。
- 作者认为，将实性 IDC-P 简单归为 Gleason 5 型模式可能不妥。
收录范围：仅采集 PubMed 摘要，未取得开放获取（OA）全文。CAP TODAY 2026 年 9 月「解剖病理精选摘要」曾选介本论文。
摘要
与常规前列腺腺癌（CPA）伴发的前列腺导管内癌（IDC-P）如何分级仍有争议，尤其是实性巢型 IDC-P 在预后上是否等同于 Gleason 5 型 CPA。我们回顾性分析了连续接受根治性前列腺切除术的患者，其 CPA 的主要、次要或第三模式中含有 5 型成分，并伴筛状 IDC-P；排除了 IDC-P 内出现粉刺样坏死的病例。随后，我们比较了伴实性模式 IDC-P（n=28［24.3%］）与不伴实性模式 IDC-P（n=87［75.7%］）患者的临床病理特征及长期肿瘤学结局。实性 IDC-P 病例与更高的淋巴结转移发生率、更大的估计肿瘤体积，以及前列腺切除术后立即接受辅助治疗的更高频率显著相关。两组在术前前列腺特异性抗原、分级组、pT 分期或手术切缘状态方面均无显著差异。单因素分析显示，实性 IDC-P 患者的无生化复发生存（P=0.010）和肿瘤特异性生存（P=0.003）显著较差。在多变量 Cox 回归分析中，校正包括分级组（风险比 1.902，P=0.039）或 5 型成分百分比（风险比 1.986，P=0.028）在内的预后因素后，实性 IDC-P 仍能显著预测术后复发。因此，实性模式 IDC-P 是接受根治性前列腺切除术男性患者的独立不良预后指标，进一步提示实性 IDC-P 与 Gleason 5 型 CPA（或筛状 IDC-P）的临床影响并不相当。因此，将实性 IDC-P 简单归为 5 型模式可能并不妥当。
- The study compared 28 patients with solid IDC-P and 87 without, excluding cases with comedonecrosis within IDC-P.
- Solid IDC-P was associated with worse biochemical recurrence-free and cancer-specific survival and independently predicted postoperative recurrence.
- The authors suggest that simply translating solid IDC-P as a Gleason grade 5 pattern may be inadequate.
Scope: Only the PubMed abstract was collected; no open-access full text was obtained. This paper was featured in CAP TODAY’s September 2026 Anatomic pathology selected abstracts.
Abstract
The grading of intraductal carcinoma of the prostate (IDC-P) associated with conventional prostatic adenocarcinoma (CPA) remains controversial, particularly regarding whether IDC-P exhibiting a solid nest pattern is prognostically equivalent to Gleason grade 5 CPA. We retrospectively analyzed consecutive radical prostatectomy patients with grade 5 CPA as a primary, secondary, or tertiary pattern, as well as cribriform IDC-P, while excluding cases exhibiting comedonecrosis within IDC-P. We then compared clinicopathologic features and long-term oncologic outcomes between those with (n=28 [24.3%]) and without (n=87 [75.7%]) solid-pattern IDC-P. Solid IDC-P cases were significantly associated with a higher incidence of lymph node metastasis, larger estimated tumor volume, and more frequent administration of adjuvant therapy immediately after prostatectomy. No significant differences were observed in preoperative prostate-specific antigen, Grade Group, pT stage, or surgical margin status between the 2 groups. Univariate analysis revealed significantly worse biochemical recurrence-free survival ( P =0.010) and cancer-specific survival ( P =0.003) in patients with solid IDC-P. In multivariable Cox regression analyses, solid IDC-P remained significantly predictive of postoperative recurrence when adjusting for prognostic factors, including Grade Group (hazard ratio 1.902, P =0.039) or the percentage of pattern 5 (hazard ratio 1.986, P =0.028). Solid-pattern IDC-P was thus found to represent an independent adverse prognostic indicator in men undergoing radical prostatectomy, further suggesting that the clinical impact of solid IDC-P versus Gleason grade 5 CPA (or cribriform IDC-P) was not comparable. It might therefore be inadequate to simply translate solid IDC-P as a grade 5 pattern.