雄激素受体、人表皮生长因子受体-2在膀胱癌伴发偶发前列腺癌组织中的表达与其临床病理特征的相关性  

Expressions of androgen receptor and human epidermal growth factor receptor 2 in urinary bladder urothelial carcinoma with incidental prostate cancer and clinicopathological features of the malignancy

作　　者：周晓蝶 石娜 王建军[3] 王璇 余波 石群立 饶秋 鲍炜 ZHOU Xiao-die;SHI Na;WANG Jian-jun;WANG Xuan;YU Bo;SHI Qun-li;RAO Qiu;BAO Wei(Department of Pathology,Jinling Hospital Affiliated to Nanjing University School of Medicine,Nanjing,Jiangsu 210002,China;Department of Pathology,Nanjing Hospital of Chinese Medicine,Nanjing,Jiangsu 210001,China;Department of Pathology,Drum Tower Hospital Affiliated to Nanjing University School of Medicine,Nanjing,Jiangsu 210008,China)

机构地区：[1]南京大学医学院附属金陵医院/东部战区总医院病理科,江苏南京210002 [2]南京市中医院病理科,江苏南京210001 [3]南京大学医学院附属鼓楼医院病理科,江苏南京210008

出　　处：《中华男科学杂志》2024年第12期1081-1085,共5页National Journal of Andrology

基　　金：国家自然科学基金面上项目(81572453);江苏省第十六批六大人才高峰项目(WSN-043);江苏省第六期333高层次人才项目[(2022)3-28-020];江苏省青年医学重点人才项目(QNRC2016918)。

摘　　要：目的:探讨膀胱尿路上皮癌(UBUC)合并偶发性前列腺癌(IPCa)的临床病理特点及预后。方法:回顾性分析2017年1月至2020年2月鼓楼医院病理科及东部战区总医院病理科行根治性膀胱前列腺切除术(RCP)后65例UBUC和38例UBUC合并IPCa的临床病理特征。采用免疫组织化学标志物雄激素受体(AR)和人表皮生长因子受体-2(HER2)比较两组间的表达情况,采用χ^(2)检验分析两组临床病理特征的差异。生存率分析采用Kaplan-Meier法和Log-rank检验。结果:UBUC合并IPCa的检出率为16.5%,有临床意义的IPCa为39.5%,术前PSA≥4μg/L的比例为23.7%。与UBUC相比,合并IPCa的UBUC多为无吸烟史[35例(92.1%)vs 48例(73.8%),P=0.024],组织学变异较少[4例(10.5%)vs 28例(43.1%),P=0.003]。相比之下,UBUC更容易发生血管侵犯[32例(49.2%)vs 8例(21.1%),P=0.005],处于进展期[44例(67.7%)vs 13例(31.6%),P<0.001]。AR在IPCa膀胱癌中的表达率明显高于UBUC[12例(31.6%)vs 6例(9.2%),P=0.004]。HER2在IPCa膀胱癌中的表达率明显高于UBUC[27例(71.1%)vs 28例(43.1%),P=0.006]。UBUC合并IPCa患者的总生存率高于UBUC患者[平均总生存率48.8个月,(95%CI 2.5~42.6个月)vs 39.9个月(95%CI 2.8~34.5个月)],但差异无统计学意义(P=0.608)。结论:RCP术后前列腺标本规范化取材有助于提高IPCa的检出率。术前PSA不能很好地预测IPCa发生的可能性。UBUC合并IPCa的患者较少有吸烟史,其膀胱癌的主要组织学类型为高级别浸润性尿路上皮癌。其预后与UBUC相比并无明显差异。HER2和AR在合并IPCa的UBUC中的表达率明显高于UBUC,提示合并IPCa的UBUC患者可能受益于HER2和AR靶向治疗。Objective:To investigate the clinicopathological features and prognosis of urinary bladder urothelial carcinoma(UBUC)with incidental prostate cancer(IPCa).Methods:We retrospectively analyzed the clinicopathological features of 65 cases of UBUC and 38 cases of UBUC+IPCa after radical cystoprostatectomy(RCP)from January 2017 to February 2020.We compared their expressions of the immunohistochemical markers androgen receptor(AR)and(human epidermal growth factor receptor 2,HER2)between the two groups of patients,and analyzed their clinicopathological characteristics by chi-square test and their survival rates using the Kaplan-Meier method and log-rank test.Results:The detection rate of UBUC+IPCa was 16.5%,and that of clinically significant IPCa was 39.5%,with preoperative PSA≥4μg/L in 23.7%of the patients.Compared with the patients with UBUC,most of the UBUC+IPCa cases had no smoking history(73.8%vs 92.1%,P=0.024),and fewer had histological variants(43.1%vs 10.5%,P=0.003).The incidence rate of vascular invasion was significantly higher in the UBUC than in the UBUC+IPCa group(49.2%vs 21.1%,P=0.005),and so was the rate of advanced cases(67.7%vs 31.6%,P<0.001).In comparison with the patients of the UBUC group,those of the UBUC+IPCa group showed remarkably higher expressions of AR(9.2%vs 31.6%,P=0.004)and HER2(43.1%vs 71.1%,P=0.006).The mean overall survival time was longer in the UBUC+IPCa than in the UBUC group(48.8 mo[95%CI:2.5-42.6 mo]vs 39.9 mo[95%CI:2.8-34.5 mo]),but with no statistically significant difference between the two groups(P=0.608).Conclusion:Standardized sampling of prostate samples after RCP helps to improve the detection rate of IPCa.Preoperative level of PSA is not a good predictor of IPCa.Few patients with UBUC+IPCa have a history of cigarette smoking,and the predominant histological type of the malignancy is high-grade invasive urothelial carcinoma,which is not significantly different from UBUC in prognosis.The expressions of HER2 and AR are significantly higher in UBUC+IPCa than in UBUC,suggesti

关 键 词：偶发前列腺癌 膀胱癌 雄激素受体 人表皮生长因子受体-2 临床病理 

分 类 号：R737.14[医药卫生—肿瘤] R737.25[医药卫生—临床医学]