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转移性前列腺癌中发生前列腺导管内癌的危险因素 被引量:1

Risk factors and misdiagnosis of intraductal carcinoma of prostate(IDC-P)in patients with metastatic prostate cancer
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摘要 目的探讨转移性前列腺癌中发生前列腺导管内癌(IDC-P)的危险因素。方法回顾性分析2018年1月至2020年7月中南大学湘雅医院收治的261例转移性前列腺癌患者的病例资料。中位年龄70(48,92)岁,其中<70岁125例,≥70岁136例。基线PSA水平≥50 ng/ml 187例,<50 ng/ml 74例。前列腺穿刺活检Gleason评分≥8分232例,<8分29例。影像学检查结果显示,153例(58.62%)有精囊腺侵犯,90例(34.48%)肿瘤累及膀胱或直肠壁,140例(53.64%)有盆腔淋巴结转移,177例(67.82%)有骨盆骨转移,149例(57.09%)有脊柱骨转移,18例(6.90%)高度怀疑肺转移。所有患者均接受超声引导经会阴前列腺12针系统穿刺,部分患者对影像学检查提示病灶加穿2~4针。根据2016年WHO肿瘤分类,判断患者病理标本是否存在IDC-P。IDC-P诊断标准为恶性上皮细胞填充大的前列腺腺泡和腺管,并保留基底细胞,形成实体型、致密筛孔型、疏松筛孔型或粉刺坏死型病理改变。结合患者临床病理资料分析伴IDC-P的危险因素。结果本研究261例,初始病理报告IDC-P检出率为9.96%(26/261),复检病理报告IDC-P检出率为29.12%(76/261)。亚组分析结果显示,PSA≥50 ng/ml组和<50 ng/ml组的IDC-P检出率分别为33.69%(63/187)和17.57%(13/74),差异有统计学意义(P=0.0039);Gleason评分≥8分组和<8分组的IDC-P检出率分别为32.33%(75/232)和3.45%(1/29),差异有统计学意义(P<0.01);不同年龄、不同转移部位亚组间IDC-P检出率差异均无统计学意义(P>0.05)。157例HE染色诊断为可疑前列腺癌标本行免疫组化染色检查,39例检出IDC-P。免疫组化染色检查P63阳性19例,其中16例检出IDC-P;ERG阳性25例,其中9例检出IDC-P;P63和ERG均阳性3例,均检出IDC-P。结论PSA≥50 ng/ml和Gleason评分≥8分是转移性前列腺癌发生IDC-P的危险因素。免疫组化染色检查标志物P63和ERG有助于确诊IDC-P。 Objective To investigate the risk factors and missed diagnosis of intraductal carcinoma of prostate(IDC-P)in patients with metastatic prostate cancer.Methods The preoperative PSA,prostate MRI,bone scans and lung CT of all patients who underwent prostate biopsy in Department of Urology,Xiangya Hospital,Central South University from January 2018 to July 2020 were reviewed.A total of 261 patients with high suspicion of metastatic prostate cancer were screened for inclusion.Two full-time senior pathologists of urogenital tumors in Xiangya Hospital independently reviewed their pathological sections and detected IDC-P according to the 2016 WHO tumor classification.Diagnostic criteria are defined as malignant epithelial cells filling large acini and prostatic ducts,with preservation of basal cells and solid or dense cribriform pattern/loose cribriform or micropapillary pattern with either marked nuclear atypia or non-focal comedonecrosis.Results The detection rate of IDC-P was 29.12%(76/261),while the actual reporting rate was only 9.96%(26/261).The results of subgroup analysis including age,PSA level,Gleason score as well as different metastatic sites showed that detection rate of IDC-P was 33.69%in the PSA≥50 ng/ml subgroup,much higher than 17.57%in the PSA<50 ng/ml subgroup(P=0.0039);And it was 32.33%in the Gleason score≥8 subgroup,much higher than 3.45%in the Gleason score<8 subgroup(P<0.01).It was not significantly different in different age subgroups as well as different metastatic site subgroups.These data suggest that PSA≥50 ng/ml as well as Gleason score≥8 may be risk factors of IDC-P.157 samples were stained by immunohistochemistry.The detection rates of IDC-P were 84.21%(16/19)in P63(+)samples,36.00%(9/25)in ERG(+)samples.There were 3 samples with both P63(+)and ERG(+),all of which had IDC-P.Conclusions There is misdiagnosis of IDC-P on prostate needle biopsy in patients with metastatic prostate cancer currently.PSA≥50 ng/ml and Gleason score≥8 are risk factors of IDC-P.Thus,attention should be paid to the possibility of IDC-P in such patients.When the diagnosis is difficult,immunohistochemical staining for ERG and P63 is helpful in IDC-P determination.
作者 罗聪 高小妹 祖雄兵 尹红玲 蔡燚 Luo Cong;Gao Xiaomei;Zu Xiongbing;Yin Hongling;Cai Yi(Department of Urology,XiangYa Hospital,Central South University,Changsha 410008,China;Department of Pathology,XiangYa Hospital,Central South University,Changsha 410008,China)
出处 《中华泌尿外科杂志》 CAS CSCD 北大核心 2023年第2期87-91,共5页 Chinese Journal of Urology
基金 湖南省重点研发计划(2021SK2014)。
关键词 前列腺肿瘤 因素分析 前列腺导管内癌 病理特点 Prostate neoplasms Carcinoma Prostate biopsy Intraductal carcinoma of prostate Pathological features
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