前列腺神经内分泌化癌患者临床特点分析  

Clinical characteristics of 13 neuroendocrine prostate cancer patients

作　　者：张炜浩[1] 司同国[1] 杨雪玲[1] 杨博[2] 刘长富[1] 于海鹏[1] 邢文阁[1] 郭志[1] 

机构地区：[1]天津医科大学肿瘤医院介入治疗肿瘤科,300060 [2]天津医科大学肿瘤医院病理科,300060

出　　处：《中华医学杂志》2017年第17期1316-1319,共4页National Medical Journal of China

基　　金：国家自然科学基金（81471761,81501568）;天津市科技支撑计划重点项目（15ZCZDSY00890）;天津市肿瘤医院院级转化医学种子基金（1414）

摘　　要：目的分析前列腺神经内分泌化癌（NEPC）患者的影像学、病理学及临床特点。方法回顾分析2004年1月至2015年1月天津医科大学肿瘤医院收治的13例经病理证实的NEPC的临床资料、影像学表现、病理特征、诊疗及预后随访资料，进行统计学分析。结果13例患者中，3例为小细胞癌，10例为腺癌内分泌治疗后转化为神经内分泌癌。临床症状主要有：尿频、尿急、夜尿增多和排尿困难。血清前列腺特异性抗原（PSA）为（14．5±3．2）μg/L；前列腺体积明显增大，为28～176（45±4）ml，病灶T2WI呈中等偏低信号影，扩散加权成像呈稍高信号，动态增强扫描显示呈“快进快出”的强化特点。免疫组化显示突触素、嗜铬素A、CD56、Ki-67呈阳性高表达。5例患者行静脉全身化疗，2例行外放射治疗，3例行局部氩氦冷冻消融治疗，3例行姑息对症治疗。13例患者的中位存活时间为10个月，5例化疗患者中位存活时间为16个月。结论NEPC临床少见，疾病进展迅速，有效治疗手段较匮乏，预后极差。提高对NEPC的早期诊断率，行化疗为主的综合治疗可使这部分患者临床受益。Objective To explore the radiological, pathological features and clinical characteristics of neuroendocrine prostate cancer patients （NEPC）. Methods The clinical characteristics and pathology data of 13 neuroendocrine prostate cancer patients treated in the Affiliated Hospital of Tianjin Medical University from January 2004 to January 2015 were analyzed retrospectively. Results Of all 13 patients, three cases were primally diagnosed small cell cancer, and 10 cases were translated to neuroendocrine type from adenocarcinoma after endocrine therapy. Frequent urination, urgency, nocturia, and dysuria were main symptoms. Serum prostate-specific antigen （PSA） was （ 14. 5 ± 3.2 ） μg/L; the volume of prostate was enlarged, mean volume,range 28 - 176（45±4）ml. The lesion was moderately low signal intensity in T2WI, while slightly higher signal in DWI. Signal characteristic of dynamic enhanced MRI was ＂fast in fast out＂. The expression of Synaptophysin, Chromogranin A , CD56 and Ki-67 in NEPC were highly expressed by immunohistochemistry analysis. Among them, five patients accepted intravenous chemotherapy, two cases received external radiation therapy, three cases received cryoablation and three cases received palliative therapy. Median survival time in all 13 patients was 10 months, while median survival time in patients treated by chemotherapy was 16 months . Conclusion NEPC is a highly aggressive subtype of prostate cancer characterized by rapid disease progression, lack of treatment and worse prognosis. Therefore, patients with NEPC may benefit from early diagnosis and comprehensive treatment with chemotherapy.

关 键 词：前列腺癌 神经内分泌化 临床特点 

分 类 号：R737.25[医药卫生—肿瘤]