摘要
目的探讨前列腺癌中神经内分泌细胞分化（NED）与抗雄激素治疗抵抗的关系。方法对55例行间歇性抗雄激素治疗的前列腺癌标本（TURP术）做单克隆嗜铬黏蛋白（CgA）抗体免疫组化染色，定期行血清PSA值及影像学检查。结果前列腺癌CgA的表达率为47．3％，神经内分泌（NE）细胞在Gleason≥7肿瘤中以巢状分布为主，而在Gleason〈7肿瘤中以单个散在分布为主，NED与Gleason分级明显相关（P〈0．05）；Ⅲ、Ⅳ期肿瘤的NED（分别为67％、71．4％）明显高于Ⅱ期肿瘤（25％）（P〈0．05）；NED与术前PSA无明显相关（P〉0．05）。中位随访时间25（5～85）个月，30例在中位治疗18（5～79）个月后转为非依赖性（A组），而25例在中位治疗31（17—85）个月后未发生疾病进展（B组），A组NED明显高于B组（P〈0．05）；单因素分析显示NE阳性、Gleason≥7、pT4期、有骨转移的肿瘤为患者PSA复发或临床进展的影响因素（P〈0．05），多因素Cox回归分析显示，NED和术前PSA值为无骨转移病例疾病进展的独立风险因素。结论NED与前列腺癌的不良生物学行为密切相关，是前列腺癌内分泌治疗产生雄激素抵抗的独立预测因子。
Objective To investigate the relationship between neuroendoerine differentiation （NED） in prostate cancer and hormone refractory prostate cancer. Methods Fifty-five prostate cancer specimens were obtained from 55 patients following intermittent androgen blockade during operation of transurethral resection of prostate. Monoclonal antibody immunohistochemistry was used to detect the expression of ehromogranin A （CgA） , a specific marker of neuroendocrinc cell in the specimens. Follow-up was conducted for 25 （5 - 85 ） months. Serum prostate specific antigen （PSA） , bone scan, chest X-ray, and computerized tomography were performed regularly during follow-up. Results Twenty-six of the 55 specimens （47.3%） were positive in CaG, and 23 of the 35 tumors with the Gleason score ≥7 was 66%, significantly higher than those of the lower-grade tumors （ all P 〈 0. 01 ）. Most of the high-grade tumors showed small cluster pattern, and most of the low-grade tumors showed solitary scattered pattern. The numbers of NED cells in the stage Ⅲ and Ⅳtumors were 67% and 71.4% respectively, both significantly higher than that of the stage Ⅱtumors （25% , both P 〈 0. 05 ）, There was no correlation between the NE positive cell rate and preoperative PSA value （ P 〉 0. 05 ）. Thirty cases progressed to a hormone-independent status within 18 （5 -79） months （Group A）, and the rest 25 cases remained not progressing within 31 （ 17 - 85 ） months （ Group B）. The NED rate of Group A was significantly higher than that of Group B （ P 〈 0. 05）. Univariate analysis showed that NE positivity, Gleason ≥ 7, stage Ⅳ, and bone metastasis were influential factors of clinical progression. Multivariate COX regression analysis showed that NED and preoperational PSA value were independent prognostic factors of bone metastasis. Conclusion NED is associated with poor prognosis and hormone refractory prostate cancer in patients with androgen deprivation therapy.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2009年第7期472-475,共4页
National Medical Journal of China
关键词
前列腺肿瘤
神经内分泌分化
预后
Prostatic neoplasms
Neuroendocrine tumors
Prognosis
