Pirus Ghadjar1, Stefanie Hayoz2, Vera Genitsch3, Daniel R Zwahlen4, Tobias Hölscher5, Philipp Gut6, Matthias Guckenberger7, Guido Hildebrandt8, Arndt-Christian Müller9, Paul M Putora10, Alexandros Papachristofilou11, Lukas Stalder2, Christine Biaggi-Rudolf2, Marcin Sumila12, Helmut Kranzbühler13, Yousef Najafi14, Piet Ost15, Ngwa C Azinwi16, Christiane Reuter17, Stephan Bodis18, Kaouthar Khanfir19, Volker Budach20, Daniel M Aebersold1, George N Thalmann21. 1. Department of Radiation Oncology, Inselspital, Bern University Hospital, Bern, Switzerland. 2. SAKK Coordinating Center, Bern, Switzerland. 3. Department of Pathology of the University of Bern, Bern, Switzerland. 4. Department of Radiation Oncology, Kantonsspital Graubünden, Chur, Switzerland. 5. University Hospital Dresden, Dresden, Germany. 6. Kantonsspital Luzern, Luzern, Switzerland. 7. University Hospital Würzburg, Würzburg, Germany. 8. University Hospital Rostock, Rostock, Germany. 9. University Hospital Tübingen, Tübingen, Germany. 10. Kantonsspital St. Gallen, St. Gallen, Switzerland. 11. University Hospital Basel, Basel, Switzerland. 12. Hirslanden Hospital Group, Zürich, Switzerland. 13. Stadtspital Triemli, Zürich, Switzerland. 14. University Hospital Zürich, Zürich, Switzerland. 15. Ghent University Hospital, Ghent, Belgium. 16. Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland. 17. Kantonsspital Münsterlingen, Münsterlingen, Switzerland. 18. Kantonsspital Aarau, Aarau, Switzerland. 19. Hôpital Valais, Sion, Switzerland. 20. Charité Universitätsmedizin Berlin, Berlin, Germany. 21. Department of Urology, Inselspital, Bern University Hospital, Bern, Switzerland.
Abstract
OBJECTIVE: 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 changes in histopathological prognostic factors, such as Gleason score. PATIENTS AND METHODS: A total of 350 patients were randomized and specimens from 279 patients (80%) were centrally reviewed by a dedicated genitourinary pathologist. Gleason score, tumour classification and resection margin status were reassessed and compared with the results of local pathology review. Agreement was assessed using contingency tables and Cohen's kappa coefficient. The association between other histopathological features (e.g. largest diameter of carcinoma) and rapid biochemical progression (up to 6 months after salvage RT) was also investigated. RESULTS: There was good concordance between central and local pathology review for seminal vesicle invasion (pT3b: 91%; κ = 0.95 [95% confidence interval {CI} 0.89, 1.00]), extraprostatic extension (pT3a/b: 94%; κ = 0.82 [95% CI 0.75, 0.89]) and positive surgical margin (PSM) status (87%; κ = 0.7 [95% CI 0.62, 0.79]). The rate of agreement was lower for Gleason score (78%; κ = 0.61 [95% CI 0.52, 0.70]). The median (range) largest diameter of carcinoma was 16 (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% 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. CONCLUSION: The results of the central pathology analyses showed concordance between central and local pathology review with regard to seminal vesicle invasion, extraprostatic extension and PSM status, but a lower rate of agreement for Gleason score. Largest diameter of carcinoma was found to be a potential prognostic factor for rapid biochemical progression after salvage RT.
RCT Entities:
OBJECTIVE: 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 changes in histopathological prognostic factors, such as Gleason score. PATIENTS AND METHODS: A total of 350 patients were randomized and specimens from 279 patients (80%) were centrally reviewed by a dedicated genitourinary pathologist. Gleason score, tumour classification and resection margin status were reassessed and compared with the results of local pathology review. Agreement was assessed using contingency tables and Cohen's kappa coefficient. The association between other histopathological features (e.g. largest diameter of carcinoma) and rapid biochemical progression (up to 6 months after salvage RT) was also investigated. RESULTS: There was good concordance between central and local pathology review for seminal vesicle invasion (pT3b: 91%; κ = 0.95 [95% confidence interval {CI} 0.89, 1.00]), extraprostatic extension (pT3a/b: 94%; κ = 0.82 [95% CI 0.75, 0.89]) and positive surgical margin (PSM) status (87%; κ = 0.7 [95% CI 0.62, 0.79]). The rate of agreement was lower for Gleason score (78%; κ = 0.61 [95% CI 0.52, 0.70]). The median (range) largest diameter of carcinoma was 16 (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% 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. CONCLUSION: The results of the central pathology analyses showed concordance between central and local pathology review with regard to seminal vesicle invasion, extraprostatic extension and PSM status, but a lower rate of agreement for Gleason score. Largest diameter of carcinoma was found to be a potential prognostic factor for rapid biochemical progression after salvage RT.
Authors: Andreas G Wibmer; Ines Nikolovski; Joshua Chaim; Yulia Lakhman; Robert A Lefkowitz; Evis Sala; Sigrid V Carlsson; Samson W Fine; Michael W Kattan; Hedvig Hricak; Hebert Alberto Vargas Journal: Radiology Date: 2021-12-21 Impact factor: 11.105
Authors: Benedict Oerther; Moritz V Buren; Christina M Klein; Simon Kirste; Nils H Nicolay; Tanja Sprave; Simon Spohn; Deepa Darshini Gunashekar; Leonard Hagele; Lars Bielak; Michael Bock; Anca-L Grosu; Fabian Bamberg; Matthias Benndorf; Constantinos Zamboglou Journal: In Vivo Date: 2020 Nov-Dec Impact factor: 2.155
Authors: Andreas G Wibmer; Michael W Kattan; Francesco Alessandrino; Alexander D J Baur; Lars Boesen; Felipe Boschini Franco; David Bonekamp; Riccardo Campa; Hannes Cash; Violeta Catalá; Sebastien Crouzet; Sounil Dinnoo; James Eastham; Fiona M Fennessy; Kamyar Ghabili; Markus Hohenfellner; Angelique W Levi; Xinge Ji; Vibeke Løgager; Daniel J Margolis; Paul C Moldovan; Valeria Panebianco; Tobias Penzkofer; Philippe Puech; Jan Philipp Radtke; Olivier Rouvière; Heinz-Peter Schlemmer; Preston C Sprenkle; Clare M Tempany; Joan C Vilanova; Jeffrey Weinreb; Hedvig Hricak; Amita Shukla-Dave Journal: Cancers (Basel) Date: 2021-05-27 Impact factor: 6.639