Christensen W N, Steinberg G, Walsh P C, Epstein J I
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
Cancer. 1991 Apr 15;67(8):2118-24. doi: 10.1002/1097-0142(19910415)67:8<2118::aid-cncr2820670818>3.0.co;2-g.
Previous studies of prostatic duct adenocarcinoma have reported a poor prognosis, but they included few patients treated by radical prostatectomy. The authors studied 15 cases treated with radical prostatectomy to define more completely their pathologic features and determine the clinical outcome in these surgically treated patients. The study included morphometry and DNA image analysis using the CAS-200 system. The most common presentation was urinary outlet obstruction (n = 9), and most patients were clinical Stage B with palpable prostatic lesions (n = 12). Compared with acinar cancers of similar clinical stage, duct cancers were large (tumor volume, 8.4 +/- 10.0 cc) and occupied a large portion of the gland (23 +/- 21%). Duct cancers were in an advanced final pathologic stage with 93% having capsular penetration, 47% positive margins, 40% seminal vesicle invasion, and 27% positive pelvic lymph nodes. The DNA analysis on cells disaggregated from paraffin revealed that 54% of cases were diploid, 15% tetraploid, 8% aneuploid, and 23% tetraploid/aneuploid. On clinical follow-up, eight patients had no evidence of tumor at intervals ranging from 1 to 28 months, and seven patients (47%) had persistent tumor at intervals of 3 to 18 months. This study demonstrates that duct cancers are in an advanced pathologic stage by the time of presentation and have a much higher short-term failure rate after radical prostatectomy compared with acinar cancers.
以往关于前列腺导管腺癌的研究报告显示其预后较差，但这些研究纳入的接受根治性前列腺切除术治疗的患者较少。作者对15例接受根治性前列腺切除术的患者进行了研究，以更全面地明确其病理特征，并确定这些接受手术治疗患者的临床结局。该研究包括使用CAS - 200系统进行形态计量学和DNA图像分析。最常见的表现是尿路梗阻（n = 9），大多数患者为临床B期，可触及前列腺病变（n = 12）。与临床分期相似的腺泡癌相比，导管癌体积较大（肿瘤体积为8.4±10.0立方厘米），占据腺体的很大一部分（23±21%）。导管癌处于晚期病理阶段，93%有包膜侵犯，47%切缘阳性，40%有精囊侵犯，27%盆腔淋巴结阳性。对从石蜡中分离出的细胞进行的DNA分析显示，54%的病例为二倍体，15%为四倍体，8%为非整倍体，23%为四倍体/非整倍体。在临床随访中，8例患者在1至28个月的随访期内无肿瘤证据，7例患者（47%）在3至18个月的随访期内有持续性肿瘤。这项研究表明，导管癌在出现时就处于晚期病理阶段，与腺泡癌相比，根治性前列腺切除术后的短期失败率要高得多。
