原发性前列腺大细胞神经内分泌癌的临床病理特征和诊治分析  

Analysis of the clinical pathological characteristics and treatment of primary prostate large cell neuroendocrine carcinoma

作　　者：李曾[1] 廖洪[1] 毛顿[1] 谭政[1] 吴毅[1] 肖英明[1] 杨盛柯 钟磊[1] 陈勇吉 LI Zeng;LIAO Hong;MAO Dun;TAN Zheng;WU Yi;XIAO Ying-ming;YANG Sheng-ke;ZHONG Lei;CHEN Yong-ji(Department of Urology,Sichuan Cancer Hospital,Chengdu 810041,China)

机构地区：[1]四川省肿瘤医院泌尿外科,成都610041

出　　处：《现代泌尿生殖肿瘤杂志》2018年第3期153-158,共6页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的总结并探讨原发性前列腺大细胞神经内分泌癌(large cell neuroendocrine carcinoma,LCNEC)的临床病理特征和治疗预后。方法结合我院收治的1例和国外文献报道的14例前列腺LCNEC的资料,回顾性分析其病理、发病机制、临床表现等特征和治疗预后等。结果15例中,12例(80.0%)为混合性(伴腺癌),其中3例为新发;3例(20.0%)为新发单纯性。免疫组化大部分表达神经内分泌指标:CgA阳性12例(80.0%),其中(++)4例(33.3%)、(+)6例(50.0%)、局灶(+)2例(16.7%);CgA(-)3例(20.0%)。Syn阳性11例(73.3%),其中(++)5例(45.4%)、(+)3例(27.3%)、局灶(+)3例(27.3%);Syn(-)4例(26.7%)。CD56/NCAM,除外未做2例,余13例中阳性10例(76.9%),其中(++)7例(53.8%)、(+)3例(23.1%);(-)3例(23.1%)。而PSA,除外未做2例,余13例中(-)8例(61.5%)、(+)2例(15.4%)、局灶(+)3例(23.1%)。采用全身化疗7例;放疗1例;内分泌治疗3例(比卡鲁胺+戈舍瑞林2例,手术去势1例);化疗联合内分泌治疗1例(我院收治的病例);化疗联合内分泌治疗和根治性前列腺切除术1例。我院收治的病例现已存活6个月,另14例中1例随访3个月后失访,2例生存分别超过15和30个月,11例最终均因转移死亡,生存时间从3周到19个月不等。总体预后差,平均生存时间<1年(11.5个月),中位生存时间约8个月。结论原发性前列腺LCNEC临床非常罕见、恶性程度高、预后差,确诊需依靠病理检查,治疗效果不理想,以手术、化疗等为主的综合疗法有利于改善其预后。Objective To investigate the clinical pathological characteristics and treatment as well as prognosis of primary prostate large cell neuroendocrine carcinoma（LCNEC）. MethodsOne case of our hospital and 14 cases reported in literature abroad who were diagnosed as prostate LCNEC were analysed retrospectively,including clinical characteristics of pathology,pathogenesis,diagnosis,treatment and prognosis. Results Twelve cases（80.0%）were mixed with adenocarcinoma,3 cases of which are de novo;3 cases（20.0%）are de novo and simple.Most immunohistochemical expression of neuroendocrine indicators：CgA positive were in 12 cases（80.0%）,（＋＋）in4 cases（33.3%）,（＋）in 6 cases（50%）,focal（＋）in 2 cases（16.7%）;（-）in 3 cases（20.0%）.Syn positive were in 11 cases（73.3%）,（＋＋）in 5 cases（45.4%）,（＋）in 3 cases（27.3%）,focal（＋）in 3 cases（27.3%）;（-）in 4 cases（26.7%）.CD56/NCAM,except for 2 cases were not made;in the remaining 13 cases,10 cases（76.9%）were positive,（＋＋）in 7 cases（53.8%）,（＋）in 3 cases（23.1%）,（-）in 3 cases（23.1%）.and PSA,except for 2 cases were not made;in the remaining 13 cases,（-）in 8 cases（61.5%）,（＋）only in 2 cases（15.4%）,focal（＋）in 3 cases（23.1%）.Chemotherapy were used in 7 cases;radiation therapy was used in 1 case;endocrinotherapy was used in 3 cases（bicalutamide＋ goserelin in 2 cases,surgical castration in 1 case）;chemotherapy combined with endocrinotherapy was used in 1 case（our case）;chemotherapy combined with endocrinotherapy and radical prostatectomy was used in 1 case.Our case was followed up for already 6 months.One case was followed up for 3 months,the other 2 cases survived more than 15 months and 30 months respectively,the rest 11 cases died of metastasis,survival time of which were from 3 weeks to 19 months.Overall prognosis was poor,the mean survival time was1 year（11.5 months）,the median survival time was about 8 months. Conclusions Primary p

关 键 词：前列腺肿瘤 神经内分泌癌 诊断 治疗 

分 类 号：R737.25[医药卫生—肿瘤]