偶发性前列腺癌的临床病理学研究  

Incidental prostate cancer:A clinicopathological study

作　　者：周晓蝶 王建军[3] 徐向军 刘宁[3] 马文亮 樊祥山[3] 石群立 鲍炜 甘卫东[1,3] ZHOU Xiao-die;WANG Jian-jun;XU Xiang-qian;LIU Ning;MA Wen-liang;FAN Xiang-shan;SHI Qun-li;BAO Wei;GAN Wei-dong(Drum Tower Clinical School of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210008,China;Department of Pathology,General Hospital of Eastern Theater Command,Nanjing,Jiangsu 210002,China;Department of Urology,Drum Tower Hospital Affiliated to Nanjing University School of Medicine,Nanjing,Jiangsu 210008,China)

机构地区：[1]南京中医药大学中西医结合鼓楼临床医学院,江苏南京210029 [2]东部战区总医院病理科,江苏南京210002 [3]南京大学医学院附属鼓楼医院泌尿外科,江苏南京210008

出　　处：《中华男科学杂志》2021年第2期145-149,共5页National Journal of Andrology

基　　金：江苏省青年医学重点人才项目(QNRC2016918)。

摘　　要：目的:探讨偶发性前列腺癌的临床病理特征及预后。方法:回顾性分析580例膀胱癌根治术中96例偶发前列腺癌的临床资料及病理学特征,并进行预后随访。结果:偶发前列腺癌的发生率为16.6%(96/580)。年龄42~90岁,中位年龄为73岁;其中≤60岁6例(6.2%),>60岁90例(93.8%)。肿瘤平均最大直径约3.5 cm(范围1.0~9.0 cm)。膀胱癌组织学类型:86例(89.6%)为高级别浸润性尿路上皮癌,其中7例伴鳞状分化,2例伴肉瘤样分化,4例伴腺样分化,1例浆细胞样尿路上皮癌;7例低级别尿路上皮癌,1例低分化神经内分泌癌,2例膀胱腺癌,其中1例印戒细胞癌。前列腺癌的组织类型均为经典型前列腺腺泡癌。Gleason评分≤6分67例(69.8%),Gleason评分≥7分29例(30.2%)。具有临床意义的偶发前列腺癌共32例(33.3%)。随访59例(61.5%),失访37例(18.2%)。平均随访时间28.7个月(1~95个月),42例(71.2%)生存,17例(28.8%)死亡(其中2例非癌症因素死亡)。余15例死亡病例中,5例有临床意义的和10例无临床意义的偶发前列腺患者中位生存时间的差别无统计学意义(P=0.322)。结论:年龄>60岁的膀胱癌患者中,偶发前列腺癌的概率高,规范化取材对其检出率影响较大,但具有临床意义的偶发前列腺癌比例较低,因此偶发前列腺癌相较膀胱癌对预后影响较小。Objective:To investigate the clinicopathological characteristics and prognosis of incidental prostate cancer(PCa).Methods:We retrospectively analyzed the clinical data and pathological characteristics of 96 cases of incidental PCa in 580 patients undergoing radical cystectomy and followed them up for prognosis.Results:The incidence rate of incidental PCa was 16.6%(96/580).The patients were 42-90 years old,with a median age of 73 years,6(6.2%)≤60 and 90(93.8%)over 60 years old.The average maximum diameter of the tumor was about 3.5 cm(range 1.0-9.0 cm).Histologically,86(89.6%)of the bladder cancer cases were high-grade invasive urothelial carcinoma(7 with squamous differentiation,2 with sarcomatoid differentiation,4 with glandular differentiation,and 1 with plasmacytoid/diffuse variant)and 7 were low-grade urothelial carcinoma,of which 1 case was poorly differentiated neuroendocrine carcinoma and 2 cases were bladder adenocarcinoma,including 1 case of signet ring cell carcinoma.All the PCa cases were classified as the histopathological type of classic acinar adenocarcinoma of the prostate,67(69.8%)with a Gleason score≤6,and 29(30.2%)with a Gleason score≥7.Of the total number of incidental PCa cases,32(33.3%)were of clinical significance,and 59(61.5%)of the patients were followed up for 1-95(mean 28.7)months,during which 42(71.2%)survived and 17(28.8%)died,including 2 deaths due to non-cancer factors.No statistically significant difference was found in the median survival time between the 5 clinically significant and 10 non-clinically significant cases(P=0.322).Conclusion:There is a high probability of incidental PCa among bladder cancer patients aged>60 years.Standardized sampling plays an important role in detection of the malignancy.There is only a small proportion of incidental PCa cases with clinical significance,and therefore it affects less the prognosis than bladder cancer.

关 键 词：膀胱癌 前列腺癌 偶发 临床病理 预后 

分 类 号：R737.25[医药卫生—肿瘤]