前列腺小细胞癌三例诊疗分析并文献复习

Diagnosis and treatment analysis of three cases with small cell carcinoma of prostate and literature review

目的探讨前列腺小细胞癌患者的诊断、治疗和预后情况,提高对前列腺小细胞癌的认识。方法对3例广东省中医院收治的前列腺小细胞癌进行病例报告,并收集国内已报道的112例前列腺小细胞癌患者的资料进行综合分析。结果本研究共115例患者,63例单纯前列腺小细胞癌患者的中位PSA为2.68 ng/ml,22例混合型前列腺小细胞癌患者的中位PSA为19.46 ng/ml,余无PSA值或病理类型不明确。临床分期以T3、T4为主,远处转移以骨转移多见,其次是肺、肝转移。115例患者中92例有随访资料,中位生存期8个月,其3个月、1年、2年生存率分别为85.7%、26.5%、17.0%。无远处转移患者中,接受化疗的中位生存期为12个月,未接受化疗的中位生存期为8个月,差异有统计学意义(P<0.05);接受局部治疗的中位生存期为15个月,未接受局部治疗的中位生存期为7个月,差异有统计学意义(P<0.05)。远处转移患者中,接受化疗的中位生存期为8个月,未接受化疗的中位生存期为5个月,差异有统计学意义(P<0.05);接受局部治疗与未接受局部治疗的患者生存时间差异无统计学意义(P>0.05)。结论前列腺小细胞癌恶性程度高,其侵袭性强、进展快、预后差,多数病例临床确诊时已是晚期,远处转移以骨转移多见。化疗能改善患者生存期,局部治疗能显著延长无远处转移患者的中位生存期。

Objective To investigate the diagnosis,treatment and prognosis of patients with small cell carcinoma of the prostate,and to improve the understanding of small cell carcinoma of the prostate.Methods Three cases of small cell carcinoma of prostate admitted to Guangdong Provincial Hospital of Traditional Chinese Medicine were reported,and the data of 112 cases of small cell carcinoma of prostate reported in China were collected and analyzed.Results The data of 115 cases were analyzed.The median PSA of 63 patients with pure prostate small cell carcinoma was 2.68 ng/ml,the median PSA of 22 patients with mixed prostate small cell carcinoma was 19.46 ng/ml,the others had no PSA valve or unclear pathological type.The clinical stages were mainly T3 and T4.Bone metastasis was more common,followed by lung and liver metastasis.92 of 115 patients had follow-up data.The median survival time was 8 months.The 3-month,1-year and 2-year survival rates were 85.7%,26.5%and 17.0%respectively.Among patients without distant metastasis,the median survival time of patients receiving chemotherapy was 12 months and that of patients not receiving chemotherapy was 8 months,the difference was statistically significant(P<0.05).The median survival time of patients who received local treatment was 15 months and that of patients who did not receive local treatment was 7 months,the difference was statistically significant(P<0.05).The median survival time of patients with distant metastasis was 8 months after receiving chemotherapy and 5 months without chemotherapy(P<0.05).There was no significant difference in survival time between receiving local treatment and not receiving local treatment in patients with distant metastasis(P>0.05).Conclusions Small cell carcinoma of the prostate has a high degree of malignancy,strong invasiveness,rapid progression and poor prognosis.Most cases are in advanced stage when clinically diagnosed,and bone metastasis is the most common distant metastasis.Chemotherapy can improve the survival time of patients,and local treatment can significantly prolong the median survival time of patients without distant metastasis.