泌尿系统神经内分泌癌的临床特征及诊治分析  

Analysis of clinical features and management methods of neuroendocrine carcinoma in urology

作　　者：杨涛[1] 谢弘[1] 傅强[1] 胡晓勇[1] 张炯[1] 宋鲁杰[1] 黄建文[1] 张慧箴[2] Yang Tao;Xie Hong;Fu Qiang;Hu Xiaoyong;Zhang Jiong;Song Lujie;Huang Jianwen;Zhang Huizhen

机构地区：[1]上海交通大学附属第六人民医院泌尿外科上海东方泌尿修复重建研究所,200233 [2]上海交通大学附属第六人民医院病理科,200233

出　　处：《中华泌尿外科杂志》2020年第7期507-511,共5页Chinese Journal of Urology

基　　金：上海市科学技术委员会资助项目(19140901702)。

摘　　要：目的分析泌尿系统神经内分泌癌(NEC)的临床特征、诊治情况及预后生存特点。方法回顾性分析2008年3月至2019年8月上海市第六人民医院收治的22例泌尿系统NEC患者的临床资料。男21例,女1例;年龄(68.2±9.9)岁。病变部位:左肾上腺1例,右肾1例,左输尿管1例,膀胱9例,前列腺10例。膀胱及前列腺NEC以肉眼血尿表现16例。影像学表现为实体软组织肿块,呈不均匀强化,局部侵犯明显。各部位肿瘤临床分期:左肾上腺T2N0M0期;右肾T4N1M0期;左输尿管T3N1M0期;膀胱T2N0M0期2例,T3N0M0期2例,T3N1M0期3例,T4N2M0期1例,T4N1M1期1例;前列腺T2N0M0期2例,T3N0M0期2例,T4N0M0期1例,T4N0M1期2例,T4N1M1期3例。治疗方法:根治性手术8例(膀胱NEC 5例,肾、输尿管、前列腺NEC各1例),肿瘤切除术1例(肾上腺NEC),姑息性切除术7例(膀胱NEC 4例,前列腺NEC 3例),保守治疗4例(前列腺NEC),2例前列腺NEC经穿刺病理诊断后失访。结果病理诊断为NEC 2例(肾上腺、前列腺各1例),小细胞神经内分泌癌(SCNEC)12例(膀胱6例,前列腺5例,肾脏1例),膀胱SCNEC混合高级别尿路上皮癌3例,前列腺SCNEC混合腺癌4例,输尿管SCNEC混合大细胞神经内分泌癌(LCNEC)1例;22例Ki-67细胞增殖指数(60.9±16.0)%,突触素阳性20例,嗜铬素A阳性10例,CD56阳性19例。20例患者获随访,中位随访时间15.5个月(8~108个月)。其中1例肾上腺NEC术后1年复发再次行肿瘤扩大切除术,第1次术后48个月带瘤生存。1例肾NEC术后18个月带瘤生存,1例输尿管NEC术后15个月因肿瘤转移死亡。膀胱NEC随访13.0个月(8~48个月),患者均死亡(死亡原因:肿瘤广泛转移6例,肾衰竭1例,根治术后多器官功能衰竭1例,脑梗死1例)。1例前列腺NEC根治术后确诊为局灶NEC并腺癌,术后随访36个月达临床治愈;1例经姑息性电切、放化疗及雄激素阻断治疗后带瘤生存108个月,余6例因肿瘤转移死亡。生存分析结果提示膀胱NEC患者1、2、3年累积生Objective To study the clinical features,management methods,and survival of patients with urinary neuroendocrine carcinoma(NEC).Methods A retrospective study of 22 patients with urinary NEC was performed from March 2008 to August 2019,including 21 male and 1 female.The average age was 68.2±9.9 years.Location of the lesion included left adrenal gland 1 case,right kidney 1 case,left ureter 1 case,bladder 9 cases and prostate 10 cases.16 cases with bladder or prostate NECs had hematuria.Radiological feature was solid tumors with inhomogeneous enhancement and obvious local invasion.Clinical TNM stages included left adrenal NEC(T2N0M0),right kidney(T4N1M0),left ureter(T3N1M0),bladder(2 cases with T2N0M0,2 with T3N0M0,3 with T3N1M0,1 with T4N2M0 and 1 with T4N1M1),prostate(2 cases with T2N0M0,2 with T3N0M0,1 with T4N0M0,2 with T4N0M1 and 3 with T4N1M1).Radical surgery was performed for 8 patients(5 with bladder NECs,1 for renal,ureter and prostate NECs respectively).Tumor resection was performed for left adrenal NEC.4 bladder NECs and 3 prostate NECs were managed with palliative resections and 4 prostate NECs with conservative treatment,2 prostate NECs lost to follow up after needle biopsy.Results Pathological results were as follows,12 cases with primary SCNECs,2 cases with NECs,3 cases were bladder SCNECs combined with high grade urothelial carcinoma,4 cases were prostate SCNECs combined with adenocarcinoma,1 case was SCNEC combined with LCNEC.Pathological tests indicated that average Ki-67 was(60.9±16.0)%,synaptophysin(SYN)was positive in 20 cases,chromogranin A(CgA)in 10 cases and CD56 in 19 cases.The median following time was 15.5 months(8-108 months)of 20 patients,16 were deceased,3 were surviving with tumor and 1 with clinical cure.The 1-,2-and 3-year overall survival rates between bladder NECs(66.7%,22.2%,11.1%)and NECs in other locations(90.9%,63.6%,42.4%)had statistical significance(P=0.038).Conclusions Hematuria was the main symptom of bladder and prostate NEC.SCNEC is the most common pathological type,man

关 键 词：癌 神经内分泌 泌尿生殖系统 诊断 治疗 

分 类 号：R737.1[医药卫生—肿瘤]