Prostate Cancer Morphologies: Cribriform Pattern and Intraductal Carcinoma Relations to Adverse Pathological and Clinical Outcomes-Systematic Review and Meta-Analysis

Prostate cancer is one of the most common male cancers. A more accurate disease assessment is needed to better stratify patients' risks and guide treatment decisions. It has already been studied that some prostate cancer submorphologies are associated with worse outcomes. We performed a systematic review and meta-analysis on the impact of distinct prostate cancer morphologies: the cribriform pattern and intraductal carcinoma on adverse pathological and clinical outcomes after radical prostatectomy. Our results showed that the cribriform pattern together with intraductal carcinoma are negative prognostic factors associated with both adverse clinical and pathological outcomes in the radical prostatectomy cohort, and the presence of those patterns should be implemented in the surgical planning and postoperative treatment guidance. The present study aimed to assess the association between the cribriform pattern (CP)/intraductal carcinoma (IDC) and the adverse pathological and clinical outcomes in the radical prostatectomy (RP) cohort. A systematic search was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement (PRISMA). The protocol from this review was registered on the PROSPERO platform. We searched PubMed((R)), the Cochrane Library and EM-BASE((R)) up to the 30th of April 2022. The outcomes of interest were the extraprostatic extension (EPE), seminal vesicle invasion (SVI), lymph node metastasis (LNS met), risk of biochemical recurrence (BCR), distant metastasis (MET) and disease-specific death (DSD). As a result, we identified 16 studies with 164 296 patients. A total of 13 studies containing 3254 RP patients were eligible for the meta-analysis. The CP/IDC was associated with adverse outcomes, including EPE (pooled OR = 2.55, 95%CI 1.23-5.26), SVI (pooled OR = 4.27, 95%CI 1.90-9.64), LNs met (pooled OR = 6.47, 95%CI 3.76-11.14), BCR (pooled OR = 5.09, 95%CI 2.23-11.62) and MET/DSD (pooled OR = 9.84, 95%CI 2.75-35.20, p < 0.001). In conclusion, the CP/IDC belong to highly malignant prostate cancer patterns which have a negative impact on both the pathological and clinical outcomes. The presence of the CP/IDC should be included in the surgical planning and postoperative treatment guidance.