前列腺恶性间叶肿瘤诊治分析(附20例报告)

Diagnosis and treatment of prostatic malignant mesenchymal tumors: Analysis of 20 cases

目的:探讨前列腺恶性间叶肿瘤(PMMT)的诊断方法、治疗手段及预后情况。方法:回顾性分析20例PMMT患者的临床资料,并对所有患者进行随访,结合文献就其诊治及预后进行讨论。结果:20例患者中,常规病理和免疫组化确诊7例为平滑肌肉瘤,5例为横纹肌肉瘤,3例为间质肉瘤,1例为软骨肉瘤,4例为未分型恶性间叶肿瘤。12例(12/20)行根治性前列腺切除术(其中3例同时行乙状结肠造瘘,1例同时行膀胱造瘘),2例(2/20)行盆腔肿块切除术(术前均动脉栓塞),1例(1/20)行全盆器官切除术,1例(1/20)行盆腔淋巴结活检+结肠造瘘术,4例(4/20)因术前影像提示肺、盆腔、骨骼等转移而行保守治疗。本组中9例(9/20)治疗后3个月内肿瘤全身转移而死亡;3例(3/20)分别为术后6、7及14个月死亡;3例(3/20)分别带瘤存活5、11、12个月;2例(2/20)无瘤存活至今已12、24个月,均为术后行周期性化疗者;3例(3/20)失访。结论:前列腺恶性间叶肿瘤恶性程度高、进展快,经直肠超声引导下穿刺活检仍是确诊PMMT的主要手段,临床分期是影响预后的重要因素,早期诊断和以根治性前列腺切除为主的综合治疗可以显著提高患者生存率。

Objective： To explore the diagnosis, treatment, and prognosis of prostatic malignant mesenchymal tumors （PMMT）. Methods ： We retrospectively analyzed the clinical and follow-up data about 20 cases of PMMT and reviewed the literature relevant to the diagnosis, treatment, and prognosis of the disease. Results： Based on the results of pathology and immunohistoche- mistry, the 20 PMMT cases included leiomyosarcoma （ n = 7）, rhabdomyosarcoma （ n = 5）, prostatic stromal sarcoma （ n = 3）, chon- drosarcoma （ n = 1 ）, and undifferentiated PMMT （ n = 4 ）. Twelve of the patients were treated by radical prostatectomy （3 concurrently by sigmoid colostomy and 1 by cystostomy） , 2 by pelvic tumor resection following arterial embolization, 1 by total pelvic exenteration, 1 by colostomy with pelvic lymph node biopsy, and 4 by conservative therapy because of metastasis to the lung, pelvis and bone. Of the 20 patients, 9 died of systemic metastasis within 3 months after treatment, 3 died at 6, 7, and 14 months, respectively, 3 survived with tumor for 5, 11, and 12 months, respectively, 2 survived without tumor for 12 and 24 months so far, all subjected to periodic chemotherapy postoperatively, and 3 lost to follow-up. Conclusion ： PMMT is a tumor of high malignancy and rapid progression, for which transrectal ultrasound-guided biopsy remains the main diagnostic method. The clinical stage of the tumor is an important factor influencing its prognosis and the survival rate of the patients can be improved by early diagnosis and combined therapy dominated by radical prostatectomy.