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PATHOLOGY
doi: 10.1590/S1677-55382010000400021
Intensity
of stromal changes predicts biochemical recurrence-free survival in prostatic
carcinoma
Tomas D, Spajic B, Miloševic M, Demirovic A, Marušic Z, Krušlin
B
Department of Pathology
Scand J Urol Nephrol. 2010; 12 [Epub ahead of print]
- Abstract:
The reactive stroma of prostate cancer contains a mixture of myofibroblasts
and fibroblasts, while fully differentiated smooth-muscle cells are
very rare or absent. In experimental prostate cancer models, prostatic
stromal cells promote angiogenesis and stimulate prostate tumorigenesis.
The aim of this study is to analyse whether the intensity of stromal
changes can predict survival in patients with prostatic carcinoma. Material
and methods: Stromal reaction was quantified histochemically and imunohistochemically
in 50 patients treated with radical prostatectomy for clinically localized
prostate carcinoma and its relationship with established prognostic
factors was assessed.
Results: Kaplan-Meier analysis showed a significant association between
the pattern of vimentin and desmin expression and the length of disease-free
period; patients with a higher vimentin or lower desmin expression had
a shorter disease-free period. On multivariate analysis only vimentin
expression (odds ratio 4.06, 95% confidence interval 1.01-16.26, p =
0.049) was a significant predictor of biochemical recurrence. In patients
with identical Gleason pattern and Gleason score the level of vimentin
expression could identify patients with a higher risk of disease recurrence.
Conclusions: Intensity of stromal changes could serve as an independent
prognostic factor in the assessment of biochemical recurrence-free survival.
Among prostate cancer patients with an identical Gleason score, it could
identify patients with a higher risk of biochemical recurrence. Thus,
stromal changes and their intensity could serve as a novel marker for
the recognition of patients with an increased risk of disease recurrence.
- Editorial
Comment
There is evidence that prostate carcinogenesis is influenced and controlled
by cellular interactions derived from a complex relationship between
stromal, epithelial and extracellular matrix components. In prostate
cancer as well as in many other cancers, the stromal microenvironment
is different from the corresponding normal stroma. There is increased
microvessel density, inflammatory cells and modified fibroblasts. The
latter are called myofibloblasts or cancer-associated fibroblasts and
are considered to play a central role in the complex process of tumor-stroma
interaction and consequently in the tumor growth, spread and metastasis,
and could also represent an important target for cancer therapies.
The study by Tomas’ et al. showed that the intensity of stromal
changes could serve as an independent prognostic factor in the assessment
of biochemical recurrence-free survival in patients submitted to radical
prostatectomy. The only other group studying the predictive value of
reactive stroma (desmoplasia) for biochemical recurrence following surgery
is from Baylor College in Houston, Texas. Yanagisawa N et al. (1) have
shown that reactive stromal grading in biopsies was correlated with
adverse pathological parameters in the prostatectomy and independent
predictor of biochemical recurrence. The authors concluded that quantitation
of reactive stroma and recognition of the desmoplastic cancer in H &
E-stained biopsies is useful to predict biochemical recurrence in prostate
carcinoma patients independent of Gleason grade and prostate-specific
antigen. Obviously more studies are needed for definitive conclusions.
Reference
- Yanagisawa
N, Li R, Rowley D, Liu H, Kadmon D, Miles BJ, et al.: Stromogenic prostatic
carcinoma pattern (carcinomas with reactive stromal grade 3) in needle
biopsies predicts biochemical recurrence-free survival in patients after
radical prostatectomy. Hum Pathol. 2007; 38: 1611-20.
Dr.
Athanase Billis
Full-Professor of Pathology
State University of Campinas, Unicamp
Campinas, São Paulo, Brazil
E-mail: athanase@fcm.unicamp.br
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