前列腺导管内癌临床、病理特征及BRCA1/2基因突变状态分析(附15例报告)  

Clinical andpathological characteristics of intraductal carcinoma of the prostate and analysis of BRCA1/2 gene mutation status(report of 15 cases)

作　　者：谢汝昊 陈博文[1] 章宏峰[2] 石玉香[2] 李学超 徐长庚[1] 汪志顺 昌磊[1] 宋正帅 罗刚 舒博 XIE Ruhao;CHEN Bowen;ZHANG Hongfeng;SHI Yuxiang;LI Xuechao;XU Changgen;WANG Zhishun;CHANG Lei;SONG Zhengshuai;LUO Gang;SHU Bo(Department of Urology,Wuhan Central Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430014,China)

机构地区：[1]华中科技大学同济医学院附属武汉市中心医院泌尿外科,武汉430014 [2]华中科技大学同济医学院附属武汉市中心医院病理科,武汉430014

出　　处：《现代泌尿生殖肿瘤杂志》2024年第4期203-207,242,共6页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的探讨前列腺导管内癌(IDC-P)的临床特点及病理特征,分析BRCA1/2基因在IDC-P中的突变状态。方法回顾性分析2017年1月至2022年3月华中科技大学附属同济医学院附属武汉市中心医院泌尿外科137例确诊为前列腺癌患者的临床资料,按照是否合并IDC-P分为IDC-P组和非IDC-P组,记录两组患者术前总前列腺特异性抗原(tPSA)水平、有无精囊侵犯、骨转移和淋巴结转移以及多参数磁共振成像分析前列腺成像报告和数据系统结节评分情况、临床T分期、Gleason评分并进行比较,同时统计BRCA1/2基因在IDC-P组中具有临床意义的突变情况。结果合并IDC-P患者15例,IDC-P在前列腺癌中的构成比为10.95%。IDC-P组具有更高的年龄(χ^(2)=29.57,P<0.05)、Gleason评分(χ^(2)=10.17,P<0.05)以及临床T分期(χ^(2)=15.20,P<0.05),更易发生骨转移(χ^(2)=4.20,P<0.05)和精囊侵犯(χ^(2)=12.83,P<0.05)。9例行前列腺根治性切除术的IDC-P患者术后BRCA1/2基因检测显示具有临床意义的突变均为阴性。1例根治术后的IDC-P患者出现了生化复发,并在治疗24个月后出现膀胱、直肠的侵犯;2例初诊时骨转移的患者治疗6个月内进展为转移性去势抵抗性前列腺癌。结论IDC-P通常具有更强的侵袭性以及更差的预后,局限性IDC-P患者积极行根治手术辅以新型内分泌治疗可使患者有更好的临床获益。Objective To explore the clinical and pathological characteristics of intraductal carcinoma of the prostate(IDC-P)and analyze the mutation status of the BRCA1/2 genes in IDC-P.Methods A retrospective analysis was conducted on the clinical data of 137 patients diagnosed with prostate cancer at the Department of Urology,Wuhan Central Hospital,Affiliated to Tongji Medical College,Huazhong University of Science and Technology,from January 2017 to March 2022.Patients were divided into IDC-P and non-IDC-P groups based on the presence of IDC-P.Preoperative total prostate-specific antigen(tPSA)levels,presence of seminal vesicle invasion,bone metastases,and lymph node metastases were recorded for both groups.Multiparametric magnetic resonance imaging was utilized to analyze the prostate imaging reporting and data system nodal scores,clinical T staging,and Gleason scores,which were then compared between the groups.Additionally,the incidence of clinically significant mutations in the BRCA1/2 genes within the IDC-P group was statistically analyzed.Results In this study,we identified IDC-P in 15 cases,accounting for 10.95%of the prostate cancer cohort.Patients in the IDC-P group exhibited elevated preoperative tPSA levels,Gleason scores,and clinical T-stages,which increased their susceptibility to bone metastases and seminal vesicle invasion.Among the 9 patients who underwent radical prostatectomy,none displayed clinically significant mutations in the BRCA1/2 genes upon postoperative genetic analysis.Post-surgery,only one patient experienced biochemical recurrence,with subsequent invasion of the bladder and rectum after 24 months of treatment.Additionally,two patients initially diagnosed with bone metastases progressed to metastatic castration-resistant prostate cancer within six months of therapy.Conclusions IDC-P is often more aggressive and has a poor prognosis,but patients with localized IDC-P may benefit from radical surgery supplemented with new endocrine therapy.

关 键 词：前列腺导管内癌 诊断 预后 治疗 BRCA1/2基因 

分 类 号：R737.25[医药卫生—肿瘤]