老年前列腺小细胞神经内分泌癌的临床特点与预后

Clinical analysis of senile patients with small cell carcinoma of prostate with neuroendocrine differentiation

目的探讨老年前列腺小细胞神经内分泌癌临床特点及预后。方法回顾性总结5例老年前列腺小细胞神经内分泌癌患者的临床资料,分析免疫组化、前列腺特异抗原(PSA)值、前列腺癌病理(Gleason评分)分级、出现激素非依赖时间等指标的相互关系及与患者生存的关系。结果5例前列腺癌活检标本均有嗜铬素A、神经特异性烯醇化酶、突触素不同程度的表达,符合前列腺小细胞神经内分泌癌诊断;4例患者确诊时有转移;5例中1例1个月死亡,1例6个月死亡,3例3年内死亡。患者5年生存率(0)明显低于同期不伴有神经内分泌分化的前列腺癌患者(67%)。确诊时(未治疗)PSA值(4.10～18.25ng/ml)均高于正常,但并非随疾病进展而升高。患者最初对全雄激素阻断治疗有效,但很快出现激素非依赖情况。小细胞前列腺癌神经内分泌分化表达水平与前列腺癌病理(Gleason评分)分级相关。结论老年前列腺小细胞神经内分泌癌患者预后差,前列腺癌神经内分泌分化相关的免疫组化和Gleason积分等指标有助于早期诊断前列腺小细胞神经内分泌癌及判断预后。

Objective To investigate the prognostic value of the small cell carcinoma of the prostate. Methods Retrospectively reviewed five cases of neuroendocrine differentiation （NED）of prostate cancer in senile patients with clinical data,immunohistochemistry, prostate-specific antigen （PSA）values, prostate cancer pathology （Gleason score ）classification, and hormone non-dependent time ,analyzing the relationship between the index and prostate cancer,and that between neuroendocrine differentiation （NED）and the survival. Results Five cases of prostate cancer biopsy specimens of ehromogranin A （CgA） ,neuron-specific enolase（NSE）, synaptophysin （Syn）different levels of expression,were consistent with small cell neuroendocrine differentiation of prostate cancer （NED）diagnosis. 4 cases had metabasis when they were diagnosed. 1 case died after 1 month, 1 patient died after 6 months, the other patients died within three years. The five-year survival rate of patients with small cell neuroendoerine differentiation of prostate cancer （NED）was significantly lower than that of other prostate carcinoma patients without NED,the average PSA values are higher than normal. Small cell neuroendoerine differentiation of prostate cancer （NED）was initially all-male hormone therapy effective ,but soon androgen-independent cases. The express of NED has positive correlation with Gleason score. Conclusions Neuroendocrine differentiation was related to the prostate cancer patients＇ survival. The combination detection of NED markers and Gleason score is beneficial to early diagnosis of prostate cancer in the elderly small cell neuroendocrine differentiation （NED） and prognosis.