UROLOGICAL SURVEY
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.
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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1Yanagisawa 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.
Patology
Publication Dates
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Publication in this collection
21 Oct 2010 -
Date of issue
Aug 2010
