前列腺小细胞神经内分泌癌诊疗特点分析

Diagnosis and treatment of small cell neuroendocrine carcinoma of the prostate

目的:探讨前列腺小细胞神经内分泌癌(SCPCa)的临床表现、病理特点及治疗进展。方法:报告SCPCa患者1例,并收集国内已报道57例SCPCa患者资料进行综合分析。结果:52例(91.2%)患者伴有尿路症状,其中尿路梗阻症状患者40例,53例(93.0%)患者前列腺触及明显异常结节,17例(29.8%)患者PSA>4μg/L。43例(75.4%)患者资料可用于临床分期评估,其中30例患者存在明确转移,20例患者存在淋巴结转移和远处转移。37例患者(64.9%)有免疫组化检查结果报道。30例(52.6%)患者资料涉及随访,随访时间1~24个月不等,中位生存时间8个月,1年生存率16.7%。26例(45.6%)患者临床资料涉及治疗方案,其中14例患者治疗方案中包含化疗,中位生存时间11个月,1年生存率28.6%。化疗患者与非化疗患者相比生存率明显升高(P<0.01)。结论:SCPCa恶性程度高,预后差,临床症状主要以尿路梗阻为主,确诊主要依靠病理学及免疫组织化学检查,治疗上推荐以化疗为基础的综合治疗方案。

Objective:To explore the clinical manifestations,pathological features and treatment of small cell neuroendocrine carcinoma of the prostate(SCPCa).Methods:We reported 1 case of SCPCa treated in Jinan People’s Hospital and analyzed the clinical data on another 57 cases reported in China.Results:Of the total number of cases,52(91.2%)had urinary tract symptoms,including 40 cases of urinary tract obstruction symptoms and 53(91.2%)had abnormal prostatic nodules on digital rectal examination,17(29.8%)with PSA>4μg/L.The clinical data on 43(75.4%)of the cases were valuable for the assessment of clinical stages,including 30 cases with confirmed metastases and another 20 with lymph node and distant metastases.Thirty-seven of the cases(64.9%)were reported with immunohistochemical results,30(52.6%)with follow-up data(followed up for 1-24 months,with median survival time of 8 months,and a 1-year survival rate of 16.7%),and another 26 with therapeutic information,14 treated by chemotherapy,with a median survival time of 11 months and a 1-year survival rate of 28.6%,significantly higher than in the non-chemotherapy groups(P<0.01).Conclusion:Small cell carcinoma of the prostate is highly malignant with poor prognosis.Its clinical symptoms mainly include urinary tract obstruction,its definite diagnosis chiefly depends on histopathology and immunohistochemistry,and its treatment recommended is chemotherapy-based comprehensive protocol.