神经内分泌前列腺癌的临床特征及诊治（2例报告并文献复习）

Clinical features,diagnosis and treatment of neuroendocrine prostate cancer(2 case reports and review of the literatures)

目的探讨神经内分泌前列腺癌(NEPC)的流行病学特点、临床表现、病理特征及诊治方案。方法回顾分析我院2017年收治2例NEPC患者的临床资料,并结合国内外文献归纳总结。结果2例患者均经病理活检明确诊断。例1为前列腺伴神经内分泌分化的低分化腺癌,术后规律去势治疗,去势治疗8个月后出现严重持续肉眼血尿,最终死于晚期肿瘤合并多器官功能衰竭。例2为神经内分泌癌,予以EP方案化疗2周期后肿物较前稍增大,化疗效果欠佳。结论NEPC临床罕见,起源不明,缺乏特异临床表现,预后较差。去势治疗提高了前列腺癌伴神经内分泌分化及去势后NEPC的比例。NEPC确诊依靠病理特征及免疫表型,早期诊断并采取手术结合放化疗的多学科综合治疗可提高患者生存率。未来从分子机制抑制、逆转NEPC或神经内分泌分化将成为重要的新型治疗策略。

Objective To investigate the epidemiological characteristics, clinical manifestations, pathological features, diagnosis and treatment of neuroendocrine prostate cancer (NEPC). Methods Clinical data of 2 patients with NEPC admitted to our hospital in 2017 were retrospectively analyzed and summarized with literatures review. Results Two patients were all diagnosed by pathological biopsy. Case 1 was a poorly differentiated prostate adenocarcinoma with neuroendocrine differentiation. After 8 months of castration treatment, the patients developed severely persistent gross hematuria and eventually died of advanced tumor with multiple organ failure. Case 2 was a neuroendocrine prostate cancer. After 2 cycles of EP chemotherapy, the tumor was slightly enlarged, indicating a poor chemotherapy effect. Conclusion NEPC is a rare malignancy with atypical clinical symptoms, unknown origin and poor prognosis. Castration treatment increased the proportion of prostate cancer with neuroendocrine differentiation and t-NEPC. Its diagnosis depends on pathological features and immunophenotype. Early diagnosis and multi-disciplinary treatment combined with surgery, radiotherapy and chemotherapy can improve patients' survival rate. In the future, inhibition or reversal of NEPC or neuroendocrine differentiation will become an important new therapeutic strategy.