Oakland University William Beaumont Medical School, 3601 W. Thirteen Mile Rd. Royal Oak, MI 48073, USA.
Int J Radiat Oncol Biol Phys. 2011 Nov 1;81(3):e119-25. doi: 10.1016/j.ijrobp.2010.12.064. Epub 2011 May 17.
To determine the prognostic significance of neuroendocrine differentiation (NED) in Gleason score 8-10 prostate cancer treated with primary radiotherapy (RT).
Chromogranin A (CgA) staining was performed and overseen by a single pathologist on core biopsies from 176 patients from the William Beaumont prostate cancer database. A total of 143 had evaluable biopsy material. Staining was quantified as 0%, <1%, 1-10%, or >10% of tumor cells. Patients received external beam RT alone or together with high-dose-rate brachytherapy. Cox regression and Kaplan-Meier estimates determined if the presence/frequency of neuroendocrine cells correlated with clinical endpoints.
Median follow-up was 5.5 years. Forty patients (28%) had at least focal positive CgA staining (<1% n = 21, 1-10% n = 11, >10% n = 8). No significant differences existed between patients with or without staining in terms of age, pretreatment prostate-specific antigen, tumor stage, hormone therapy administration, % biopsy core involvement, mean Gleason score, or RT dose/modality. CgA staining concentration independently predicted for biochemical and clinical failure, distant metastases (DM), and cause-specific survival (CSS). For patients with <1% vs. >1% staining, 10-year DM rates were 13.4% vs. 55.3%, respectively (p = 0.001), and CSS was 91.7% vs. 58.9% (p < 0.001). As a continuous variable, increasing CgA staining concentration predicted for inferior rates of DM, CSS, biochemical control, and any clinical failure. No differences in outcomes were appreciated for patients with 0% vs. <1% NED.
For Gleason score 8-10 prostate cancer, >1% NED is associated with inferior clinical outcomes for patients treated with radiotherapy. This relates most directly to an increase in distant disease failure.
确定在接受原发性放射治疗（RT）的 Gleason 评分 8-10 前列腺癌中神经内分泌分化（NED）的预后意义。
对来自 William Beaumont 前列腺癌数据库的 176 名患者的核心活检进行了嗜铬粒蛋白 A（CgA）染色，并由一名病理学家进行了监督。共有 143 名患者具有可评估的活检材料。染色的定量为 0％，<1％，1-10％或>10％的肿瘤细胞。患者单独接受外照射 RT 或与高剂量率近距离放射治疗联合治疗。Cox 回归和 Kaplan-Meier 估计确定神经内分泌细胞的存在/频率是否与临床终点相关。
中位随访时间为 5.5 年。40 名患者（28％）的 CgA 染色至少有局灶性阳性（<1％n = 21，1-10％n = 11，>10％n = 8）。在有无染色的患者之间，年龄，治疗前前列腺特异性抗原，肿瘤分期，激素治疗的使用，活检核心受累的百分比，平均 Gleason 评分或 RT 剂量/方式均无显着差异。CgA 染色浓度独立预测生化和临床失败，远处转移（DM）和原因特异性生存（CSS）。对于<1％与>1％染色的患者，10 年 DM 发生率分别为 13.4％和 55.3％（p = 0.001），CSS 分别为 91.7％和 58.9％（p <0.001）。作为连续变量，CgA 染色浓度的增加预示着 DM，CSS，生化控制和任何临床失败的发生率较低。对于 0％与<1％NED 的患者，结果无差异。
对于 Gleason 评分 8-10 的前列腺癌，接受放疗的患者中>1％的 NED 与较差的临床结果相关。这与远处疾病失败的增加最直接相关。
