Bostwick David G, Bostwick Kathleen C
Mayo Clinic, Rochester, Minnesota, USA.
BJU Int. 2004 Jul;94(1):57-8. doi: 10.1111/j.1464-410X.2004.04900.x.
To determine the incidence and long-term follow-up of the 'vanishing cancer' phenomenon, as complete sampling of some radical prostatectomy (RP) specimens reveals no residual cancer.
The Mayo Clinic prostate cancer RP database for 1966-1995 was searched for all cases in which there was no residual adenocarcinoma (pathological stage pT0). Each case was confirmed by a review of all tissue specimen slides. Various clinical and pathological features were evaluated, and the follow-up obtained for all patients.
Among 6843 RPs there were 38 in which no residual cancer was identified despite careful sampling. There was a 10-fold decline in the incidence of this finding, from 2.1% before 1980 to 0.2% in 1993-95; this decline appeared to be caused by a decrease in the frequency of diagnosis of cancer by transurethral resection from > 10% before 1990 to < 2% in 1993-95. The mean (range) age of the patients was 63 (38-75) years. All cancers on biopsy or transurethral resection were well or moderately differentiated; clinical stages included T1a (42% of cases), T1b (45%) and T2 (13%). Six patients had a nerve-sparing RP, all after 1990. The mean follow-up was 9.6 (1.0-28.5) years, and there were no recurrences of cancer; the serum prostate specific antigen concentration remained at < 0.2 ng/mL in surviving patients. Six patients (16%) died from intercurrent disease.
The incidence of 'vanishing cancer' declined between 1966 and 1995, probably as a result of the decline in the use of transurethral resection, occurring in 0.2% of RPs. The prognosis in such patients is excellent, indicating that there is no apparent clinical significance to microscopic foci of cancer that remain undetected after reasonably complete pathological sampling. The inability to identify cancer in a prostate removed for biopsy-confirmed carcinoma does not indicate technical failure.
确定“消失的癌症”现象的发生率及长期随访情况，因为对一些根治性前列腺切除术（RP）标本进行完整取样后未发现残留癌症。
检索梅奥诊所1966年至1995年的前列腺癌RP数据库，查找所有无残留腺癌（病理分期pT0）的病例。通过复查所有组织标本玻片对每个病例进行确认。评估各种临床和病理特征，并对所有患者进行随访。
在6843例RP中，有38例尽管经过仔细取样仍未发现残留癌症。这一发现的发生率下降了10倍，从1980年前的2.1%降至1993 - 1995年的0.2%；这种下降似乎是由于经尿道切除术诊断癌症的频率降低所致，从1990年前的>10%降至1993 - 1995年的<2%。患者的平均（范围）年龄为63（38 - 75）岁。活检或经尿道切除的所有癌症均为高分化或中分化；临床分期包括T1a（42%的病例）、T1b（45%）和T2（13%）。6例患者接受了保留神经的RP，均在1990年之后。平均随访时间为9.6（1.0 - 28.5）年，无癌症复发；存活患者的血清前列腺特异性抗原浓度保持在<0.2 ng/mL。6例患者（16%）死于并发疾病。
1966年至1995年间，“消失的癌症”发生率下降，可能是由于经尿道切除术使用减少所致，在RP中发生率为0.2%。此类患者的预后极佳，表明在合理完整的病理取样后仍未检测到的癌症微小病灶无明显临床意义。在因活检确诊的癌而切除的前列腺中未能发现癌症并不表明技术失败。
