定量分析 pT3a pN0 M0 R0 前列腺癌患者的前列腺外神经周围间隙浸润及其预后价值。

Quantification of extraprostatic perineural spread and its prognostic value in pT3a pN0 M0 R0 prostate cancer patients.

机构信息

Department of Pathology, Medical University of Vienna, Vienna, Austria.

出版信息

Prostate. 2011 Dec;71(16):1790-5. doi: 10.1002/pros.21396. Epub 2011 May 11.

DOI:10.1002/pros.21396

PMID:21563191

Abstract

BACKGROUND

The prognostic relevance of the amount of extraprostatic cancer spread in nerves in prostate cancer patients is not well established.

METHODS

Eighty-eight patients were included in our study with pT3a pN0 M0 R0 prostate cancer treated with retropubic prostatectomy. Eighty-seven of them showed perineural invasion, 54 were confined to the prostate, 33 showed cancer spread in extraprostatic nerves, which was quantified by counting each transverse section of nerves infiltrated by cancer in totally embedded specimens. Biochemical relapse was established by serum PSA levels of ≥0.2 ng/ml as well as PSA ≥ 0.4 ng/ml and higher according to the EAU guidelines.

RESULTS

Extraprostatic but not intraprostatic perineural infiltration was significantly more often found in tumors of higher Gleason score. Intraprostatic number of infiltrated nerves (NIN) correlated with extraprostatic NIN. There was no association between extraprostatic or intraprostatic NIN and Gleason score, lymphatic, or blood vessel invasion. Extraprostatic neural infiltration in ≤10 nerves extended relapse free survival in univariate analysis for PSA 0.2 and 0.4 ng/ml (P = 0.002 and P < 0.000001, respectively) and remained significant in multivariate analysis for PSA 0.4 ng/ml (P = 0.039).

CONCLUSIONS

High amount of extraprostatic NIN correlates with tumor progression and seems to be an independent prognostic parameter.

摘要

背景

在前列腺癌患者中，神经周围癌细胞扩散的程度与预后的相关性尚未得到充分证实。

方法

本研究纳入了 88 例接受经耻骨后前列腺切除术治疗的 pT3a pN0 M0 R0 前列腺癌患者。其中 87 例患者存在神经周围侵犯，54 例局限于前列腺内，33 例存在前列腺外神经周围癌细胞扩散，通过对完全包埋标本中受癌细胞浸润的神经的每个横切面进行计数来定量评估。生化复发通过血清 PSA 水平≥0.2ng/ml 以及根据 EAU 指南 PSA≥0.4ng/ml 且更高来确定。

结果

神经周围而非神经内侵犯在高 Gleason 评分的肿瘤中更为常见。前列腺内神经浸润数量（NIN）与前列腺外 NIN 相关。前列腺内或前列腺外 NIN 与 Gleason 评分、淋巴管或血管侵犯之间无相关性。在单变量分析中，≤10 根神经的前列腺外神经浸润与 PSA 0.2 和 0.4ng/ml 的无复发生存期相关（P=0.002 和 P<0.000001），在多变量分析中，与 PSA 0.4ng/ml 的无复发生存期相关（P=0.039）。