The Association of Invasive Cribriform Lesions With Adverse Prostatic Adenocarcinoma Outcomes An Institutional Experience, Systematic Review, and Meta-analysis

Context.-Recent studies and a few reviews suggest that presence of invasive cribriform lesions (ICLs) in prostatic acinar adenocarcinoma correlates with adverse outcomes. However, a systematic review with meta-analysis on this correlation is currently lacking. Objective.-To compare the likelihood of adverse outcomes by the status of ICLs in prostatic acinar adenocarcinoma with the meta-analysis of high-quality published data and institutional experience. Data Sources.-PubMed, Scopus, manually searched references, and institutional data. Study Selection.-Observational retrospective case-control studies or prospective cohort studies of adverse outcomes stratified by the status of ICLs were selected. Data Extraction.-Study quality was analyzed. The prevalence of adverse outcomes stratified by the status of ICLs was extracted. Conclusions.-Eighty-five cases were reviewed. Extra-prostatic extension, seminal vesicle invasion, and regional lymph node metastasis were observed in 18 (45%), 14 (35%), and 7 (17.5%) of the 40 cases with cribriform lesions, respectively. These features were observed in 4 (8.9%), 1 (2.2%), and 0 (0%) of the 45 cases without ICLs. During the follow-up, biochemical prostate-specific antigen recurrence, local recurrence, and metastasis/diseasespecific death were documented in 7 (17.5%), 2 (5%), and 2 (5%) of the 40 cases with ICLs. These poor outcomes were found in 6 (13.3%), 1 (2.2%), and 1 (2.2%) of the 45 cases without ICLs. Meta-analysis revealed a significant increase in the risk of adverse outcomes in patients who had ICLs relative to those who did not (odds ratio, 3.95; 95% CI, 2.61-5.97; I-2 = 53%; Z = 6.52; P < .01). These results suggest that presence of ICLs is associated with adverse outcomes.