Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
Prostate. 2014 May;74(5):520-7. doi: 10.1002/pros.22771. Epub 2013 Dec 30.
To demonstrate the association of neuroendocrine differentiation, as identified by chromogranin A (CgA) staining, with clinical outcomes in newly diagnosed prostatic adenocarcinoma treated with definitive radiotherapy (RT).
MATERIALS/METHODS: Patients with Gleason score ≥7 adenocarcinoma were identified from our outcomes database. RT consisted of external beam, brachytherapy, or external beam with brachytherapy boost. Biopsy specimens were stained for neuroendocrine differentiation with CgA. Results were interpreted by a single pathologist. CgA staining was quantified as 0%, <1%, 1-10%, or >10% of tumor cells. Clinical outcomes were blinded at the time of pathologic evaluation.
CgA staining was performed on 289 patients. 149 patients had Gleason score 7, and 140 were Gleason score 8-10. Median follow-up was 6.5 years. For patients with <1% versus >1% CgA staining, pretreatment characteristics were well-balanced. CgA staining was detected in 90 cases (31%). 58 patients had focal positive (<1%) CgA staining, and 32 cases had >1% of tumor cells CgA positive. Patients with >1% CgA staining had inferior biochemical control, clinical failure, distant metastases (DM), and cause-specific survival (CSS) rates. Ten-year rates of DM were 8% versus 48% for patients with <1% versus >1% CgA positive cells, respectively (P < 0.001). CSS at 10 years was 95% versus 76%, respectively (P < 0.001). Local control was equivalent in the two patient cohorts. Patients with <1% CgA staining had similar outcomes to those patients with 0% staining.
Neuroendocrine differentiation involving >1% of tumor cells on prostate cancer biopsies is a predictor of DM and CSS in patients treated with primary RT.
通过免疫组化染色检测嗜铬粒蛋白 A（CgA），探讨其在新诊断前列腺腺癌患者接受根治性放疗（RT）后的临床意义。
材料/方法：从我们的数据库中确定了 Gleason 评分≥7 分的腺癌患者。RT 包括外照射、近距离放疗或外照射联合近距离放疗。用 CgA 对神经内分泌分化进行免疫组化染色。结果由一名病理学家进行解读。CgA 染色结果为肿瘤细胞 0%、<1%、1%-10%和>10%。在病理评估时，临床结果是盲法的。
对 289 例患者进行了 CgA 染色。149 例患者 Gleason 评分 7 分，140 例患者 Gleason 评分 8-10 分。中位随访时间为 6.5 年。在 CgA 染色<1%和>1%的患者中，治疗前的特征是均衡的。90 例（31%）患者检测到 CgA 染色阳性。58 例患者有局灶性弱阳性（<1%）CgA 染色，32 例患者有>1%的肿瘤细胞 CgA 染色阳性。CgA 染色阳性患者的生化控制、临床失败、远处转移（DM）和肿瘤特异性生存（CSS）率均较差。10 年时 DM 发生率分别为 8%和 48%，CgA 染色阳性细胞<1%和>1%的患者（P<0.001）。10 年 CSS 率分别为 95%和 76%，CgA 染色阳性细胞<1%和>1%的患者（P<0.001）。两组患者的局部控制率相当。CgA 染色<1%的患者与 0%染色的患者具有相似的结局。
前列腺癌活检中肿瘤细胞>1%出现神经内分泌分化是接受根治性 RT 治疗的患者发生 DM 和 CSS 的预测因素。
