神经内分泌前列腺癌20例临床病理特征及预后分析

Clinicopathologic characteristics and prognosis of neuroendocrine prostate carcinoma:an analysis of 20 cases

目的:探讨神经内分泌前列腺癌(NEPC)的临床病理特征及预后情况。方法:回顾性分析我院2010年1月~2017年7月收治的20例NEPC的临床特征、病理特点、治疗及预后。结果:20例NEPC患者发病年龄59~78岁,平均68.4岁。临床症状主要包括排尿不畅及肉眼血尿等。确诊时血清前列腺特异性抗原(PSA)0.18~24.29μg/L,平均4.08μg/L。临床分期局限性T_(2a)~T_(3a)8例,局限进展性T_(3b)~T_(4)8例,远处转移M_1 4例。免疫组化染色结果嗜铬素A阳性率为65%(13/20),突触素阳性率为90%(18/20),CD56阳性率为85%(17/20),P53阳性率为25%(5/20)。13例患者行静脉化疗,5例患者行手术治疗,其中4例患者术后辅以化疗,2例患者行姑息治疗。随访时间2~22个月(平均10.1个月),中位生存时间9个月,其中17例行静脉化疗患者的中位生存时间为11个月。结论:NEPC是一类少见的特殊类型前列腺癌,病理形态复杂,神经内分泌指标染色检测是确诊该病的可靠依据。静脉化疗短期可提高患者的生存率。

Objective：To study the clinicopathologic features and prognosis of neuroendocrine prostate carcinoma（NEPC）.Method：All NEPC patients admitted between January 2010 and July 2017 to Renji Hospital were included.The clinicopathologic data,treatment and prognosis were retrospectively analyzed.Result：A total of 20 patients were indentified,ranging in age from 59 to 78 years old（mean,68.4）.Lower urinary tract symptoms including dysuria and gross hematuria were main symptoms.Mean serum prostate specific antigen（PSA）at diagnosis was 4.08μg/L.According to TNM clinical staging,localized tumor was found in 8 cases,locally advanced tumor in 8 cases,and metastatic tumor in 4 cases.The immunohistochemical results showed that the positive rates for chromogranin A,synaptophysin and CD56 were 65%（13/20）,90%（18/20）and 85%（17/20）.Five cases were positive for P53.Thirteen patients were treated with intravenous chemotherapy,five patients received surgery,while the remaining 2 cases accepted palliative therapy.Mean follow-up period was 10.1 months.Median survival time was 9 months,while median survival time in patients treated by chemotherapy was 11 months.Conclusion：NEPC is a rare and distinct category with different histological subtypes.The diagnosis of NEPC should depend on the neuroendocrine markers detected by the immunohistochemistry.Comprehensive treatment with chemotherapy may improve the overall survival rates in short term.