Purpose: Given the diverse clinical progression of prostate cancer (PC) and the evolving significance of histopathological factors in its management, this study aimed to explore the impact of cribriform pattern 4 (CP4) on clinical outcomes in PC patients and examine its molecular characteristics. Methods: This retrospective study analyzed data from The Cancer Genome Atlas (TCGA) database and included PC patients who underwent radical prostatectomy (RP) and had pathology slides available for the assessment of CP4. A multivariable competing risk regression analysis was used to assess the association between CP4 and progression-free survival (PFS) while adjusting for established PC prognostic factors. The frequency of genomic alterations was compared between patients with and without CP4 using the Fisher’s exact test. Results: Among the 394 patients analyzed, 129 (32.74%) had CP4. After a median follow-up of 40.50 months (IQR: 23.90, 65.60), the presence of CP4 was significantly associated with lower PFS (AHR, 1.84; 95% CI, 1.08 to 3.114;p= 0.023) after adjusting for covariates. Seven hub genes—KRT13, KRT5, KRT15, COL17A1, KRT14, KRT16, and TP63—had significantly lower mRNA expression levels in patients with CP4 compared to those without. Conclusions: PC patients with CP4 have distinct genomic alterations and are at a high risk of disease progression following RP. Therefore, these patients may benefit from additional post-RP treatments and should be the subject of a prospective randomized clinical trial.
目的：鉴于前列腺癌（PC）临床进展的多样性以及组织病理学因素在其治疗中日益凸显的重要性，本研究旨在探讨筛状结构4型（CP4）对PC患者临床结局的影响，并分析其分子特征。方法：本回顾性研究分析了癌症基因组图谱（TCGA）数据库的数据，纳入接受根治性前列腺切除术（RP）且拥有可用于CP4评估的病理切片的PC患者。采用多变量竞争风险回归分析评估CP4与无进展生存期（PFS）的关联，同时校正已确立的PC预后因素。使用Fisher精确检验比较CP4阳性与阴性患者基因组改变的频率。结果：在分析的394例患者中，129例（32.74%）存在CP4。中位随访40.50个月（IQR：23.90，65.60）后，在校正协变量后，CP4的存在与较低的PFS显著相关（调整后风险比，1.84；95% CI，1.08至3.114；p=0.023）。与无CP4的患者相比，CP4阳性患者中七个枢纽基因——KRT13、KRT5、KRT15、COL17A1、KRT14、KRT16和TP63的mRNA表达水平显著降低。结论：伴有CP4的PC患者具有独特的基因组改变，且在RP后疾病进展风险较高。因此，这些患者可能受益于RP后的额外治疗，并应成为前瞻性随机临床试验的研究对象。
肿瘤(癌症)患者之家