Osunkoya Adeboye O, Nielsen Matthew E, Epstein Jonathan I
Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA.
Am J Surg Pathol. 2008 Mar;32(3):468-72. doi: 10.1097/PAS.0b013e3181589f72.
Mucinous adenocarcinoma of the prostate is one of the least common variants of prostate cancer. The prognosis of this variant of prostate cancer remains controversial. We present 47 cases (1991 to 2006) of mucinous carcinomas treated by radical prostatectomy. Mean patient age at diagnosis was 56 years (range: 44 to 69 y). The mean preoperative prostate-specific antigen (PSA) level was 9.0 ng/mL (range: 1.9 to 34.3 ng/mL). Clinical stages were T1c (34 cases), T2a (7 cases), and T2b (6 cases). The mean percentage of tumor composed of the mucinous component was 52% (range: 25% to 90%). The mean Gleason score was 7 with scores of 6 in 6 cases (12.8%), 7 in 37 cases (78.7%), and 8 in 4 cases (8.5%). Margins were positive in 4 cases of mucinous adenocarcinoma of the prostate. Only 2 cases had isolated margin positivity in the nonmucinous acinar component of cancer. In 12 cases (25.5%), mucinous adenocarcinoma had established extraprostatic extension (EEPE). Eight cases (17.0%) had isolated EEPE of nonmucinous cancer. The 1 lymph node metastasis contained nonmucinous cancer. All together, taking into account both the mucinous and nonmucinous tumor, 20/47 cases (42.5%) had EEPE and 6/47 (12.7%) had positive margins. The 1 lymph node metastasis contained nonmucinous cancer. The mean follow-up for those without progression was 5.6 years (median 6 y, range: 1 to 15 y). One patient (2.1%) progressed 3 years after his radical prostatectomy (5 y actuarial progression-free risk 97.2%). Using the Kattan nomogram, the predicted mean 5-year PSA progression-free risk for nonmucinous prostate cancer with the same PSA and postoperative findings as in the current study was 85.4%. This study confirms that mucinous adenocarcinoma of the prostate treated by radical prostatectomy is not more aggressive, and possibly even less aggressive than nonmucinous prostatic adenocarcinoma.
前列腺黏液腺癌是前列腺癌中最不常见的变异类型之一。这种前列腺癌变异类型的预后仍存在争议。我们呈现了47例（1991年至2006年）接受根治性前列腺切除术治疗的黏液腺癌病例。诊断时患者的平均年龄为56岁（范围：44至69岁）。术前前列腺特异性抗原（PSA）的平均水平为9.0 ng/mL（范围：1.9至34.3 ng/mL）。临床分期为T1c（34例）、T2a（7例）和T2b（6例）。肿瘤中黏液成分的平均比例为52%（范围：25%至90%）。Gleason评分平均为7分，其中6分的有6例（12.8%），7分的有37例（78.7%），8分的有4例（8.5%）。4例前列腺黏液腺癌的手术切缘呈阳性。仅2例在癌的非黏液腺泡成分中有孤立的切缘阳性。12例（25.5%）黏液腺癌出现了前列腺外扩展（EEPE）。8例（17.0%）有非黏液癌的孤立性EEPE。1例淋巴结转移包含非黏液癌。综合考虑黏液性和非黏液性肿瘤，47例中有20例（42.5%）出现EEPE，47例中有6例（12.7%）切缘阳性。1例淋巴结转移包含非黏液癌。无疾病进展患者的平均随访时间为5.6年（中位数6年，范围：1至15年）。1例患者（2.1%）在根治性前列腺切除术后3年出现疾病进展（5年精算无进展风险为97.2%）。使用Kattan列线图，对于与本研究中PSA及术后表现相同的非黏液性前列腺癌，预测的平均5年无PSA进展风险为85.4%。本研究证实，接受根治性前列腺切除术治疗的前列腺黏液腺癌并不比非黏液性前列腺腺癌更具侵袭性，甚至可能侵袭性更小。
