合并神经内分泌分化前列腺腺癌23例病例报告及文献复习  

Neuroendocrine differentiated prostate adenocarcinoma:Report of 23 cases and review of the literature

作　　者：邓梁 龙智[1,2] 何乐业[1,2] 汤进[1,2] 刘建业[1,2] 刘斌[1,2] 姚鲲[1,2] 张一川[1,2] DENG Liang;LONG Zhi;HE Le-ye;TANG Jin;LIU Jian-ye;LIU Bin;YAO Kun;ZHANG Yi-chuan(Department of Urology,The Third Xiangya Hospital,Central South University,Changsha,Hunan 410013,China;Research Institute of Prostatic Diseases,Central South University,Changsha,Hunan 410013,China)

机构地区：[1]中南大学湘雅三医院泌尿外科,湖南长沙410013 [2]中南大学前列腺疾病研究所,湖南长沙410013

出　　处：《中华男科学杂志》2020年第1期42-47,共6页National Journal of Andrology

基　　金：湖南省自然科学基金(2017JJ2370)。

摘　　要：目的:探讨合并神经内分泌分化(NED)前列腺腺癌的临床特征及预后,提高对神经内分泌癌的认识。方法:回顾性分析2005年至2018年收治的23例确诊前列腺腺癌伴NED患者的临床资料。结果:23例病例中,18例以下尿路症状(LUTS)来就诊。所有患者病理诊断为腺癌并局灶NED,其中2例第1次病理诊断为腺癌,内分泌治疗出现去势抵抗后,再次病理检查发现部分NED。所有患者均接受了内分泌治疗,3例患者接受了根治性手术治疗,并行辅助化疗、放疗或内分泌治疗;13例患者接受了姑息性经尿道前列腺等离子电切术(pTUPKRP)和辅助内分泌治疗,其中2例出现去势抵抗,再次接受pTU-PKRP,并给予化疗;2例患者因盆腔广泛转移,导致梗阻性肾病(尿毒症期),接受了经皮肾穿刺造瘘引流术和内分泌治疗;余5例患者仅行单纯内分泌治疗或联合放疗。随访7~60个月后,2例因肿瘤进展死亡,1例死于肺部感染,其余患者均存活。结论:长期的内分泌治疗可能导致前列腺腺癌发生NED改变,根治性手术结合辅助治疗是治疗早期患者的主要方式;内分泌治疗联合经尿道手术可以改善中晚期患者的LUTS,提高生活质量。Objective:To study the clinical features and prognosis of neuroendocrine differentiated prostate adenocarcinoma(NED/AdPC).Methods:We retrospectively analyzed the clinical data on 23 cases of NED/AdPC treated between 2005 and 2018,among which,18 had lower urinary tract symptoms(LUTS).Results:All the 23 patients were diagnosed with NED/AdPC,including 2 cases of AdPC initially diagnosed and confirmed with neuroendocrine differentiation in a second pathological diagnosis after androgen deprivation therapy(ADT).In addition to hormonal therapy for all the cases,3 of the patients were treated by radical prostatectomy combined with adjuvant chemo-and radiotherapy,13 by palliative transurethral bipolar plasmakinetic resection of the prostate(pTU-PKRP),of whom 2 underwent a second pTU-PKRP and chemotherapy for castration resistance,2 with chronic renal insufficiency by percutaneous nephrostomy because of extensive pelvic metastasis,and the other 5 by ADT alone or in combination with radiother apy.During the follow-up of 7 to 60 months,2 of the patients died of cancer progression and 1 of pulmonary infection,while the others survived with effective control of the tumor.Conclusion:Long-term ADT may induce neuroendocrine differentiation in AdPC patients.For early-stage NED/AdPC,radical prostatectomy combined with adjuvant therapy is a main therapeutic option,while for advanced NED/AdPC,pTU-PKRP in combination with ADT may relieve LUTS and improve the patients'quality of life.

关 键 词：前列腺腺癌 神经内分泌分化 治疗 生活质量 

分 类 号：R737.25[医药卫生—肿瘤]