HISTOLOGICAL GRADE, PERINEURAL INFILTRATION, TUMOR-INFILTRATING LYMPHOCYTES AND APOPTOSIS AS DETERMINANTS OF LONG-TERM PROGNOSIS IN PROSTATIC ADENOCARCINOMA

A series of 325 prostatic adenocarcinomas with a long-term clinical fo llow-up were subjected to light microscopic analysis of histological p rognostic factors, including three grading systems (Gleason score, WHO grade, nuclear grade), perineural infiltration of the tumour (PNI), t umour infiltrating lymphocytes (TIL) and the presence of apoptotic cel ls (APO). All three histological classifications correlated significan tly with the prognosis, but in multivariate analysis, the Gleason scor e was superior to the WHO grading or nuclear grading in predicting pat ient survival. PNI was significantly related to poor differentiation o f the tumour, its progression and ominous disease outcome, particularl y in T1-2MO tumours. The density of TIL was independent of the tumour differentiation, and absent or weak TIL were signs of a high risk of t umour progression and of a fatal disease. Apoptotic cells were commonl y detected in poorly differentiated tumours and apoptosis was related to disease progression and low survival probability. The results sugge st that the Gleason score, PNI and the density of TIL should be includ ed in routine pathology reports, to be used by clinicians while making therapeutic decisions in prostatic cancer.