Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
Clin Genitourin Cancer. 2017 Oct;15(5):e793-e800. doi: 10.1016/j.clgc.2017.04.006. Epub 2017 Apr 13.
Neuroendocrine carcinoma of the prostate (NEPC) is a rare entity. We aimed at providing contemporary data on incidence and survival figures of de-novo NEPC.
Within the Surveillance, Epidemiology, and End Results (SEER) database, we identified 309 individuals with de-novo NEPC diagnosed between 2004 and 2013. We evaluated age-adjusted incidence rates over the study. Kaplan-Meier analyses assessed overall survival (OS) after stratification according to histologic subtype, metastatic status, and treatment. Cox regression analyses tested the predictors of overall mortality, after adjusting for confounders.
A total of 309 cases of NEPC were identified from 510,913 cases of prostate cancer. Metastatic disease was identified in 198 (64.1%) cases. The most common histologic subtype (n = 186; 60.2%) was small-cell carcinoma (SCC). The age-adjusted incidence of NEPC significantly increased over the study span. However, this increase only affected SCC (from 0.13/1,000,000 person-years in 2004 to 0.30/1,000,000 person-years in 2013; P = .001). Median survival for NEPC was 10 months. After stratification by metastatic status, no difference was observed according to SCC versus non-SCC. Treatment with radical prostatectomy improved OS only among individuals with non-metastatic disease, whereas radiation therapy did not affect OS rates. In multivariable Cox regression analyses predicting overall mortality, metastatic stage (hazard ratio, 1.52; 95% confidence interval, 1.12-2.06; P < .01) and radical prostatectomy (hazard ratio, 0.38; 95% confidence interval, 0.20-0.74; P < .01) achieved independent predictor status.
De-novo NEPC is extremely rare and will be encountered in clinical practice by few urologists. Most cases are metastatic at diagnosis. Prognosis is poor regardless of histologic type, especially in metastatic stage.
前列腺神经内分泌癌（NEPC）是一种罕见的实体瘤。我们旨在提供关于原发性 NEPC 的发病率和生存数据的最新信息。
在监测、流行病学和最终结果（SEER）数据库中，我们确定了 309 名在 2004 年至 2013 年间被诊断为原发性 NEPC 的患者。我们评估了研究期间的年龄调整发病率。Kaplan-Meier 分析根据组织学亚型、转移状态和治疗方法对总生存率（OS）进行分层评估。Cox 回归分析在调整混杂因素后测试了总体死亡率的预测因素。
从 510913 例前列腺癌患者中确定了 309 例 NEPC 病例。198 例（64.1%）患者存在转移性疾病。最常见的组织学亚型（n=186；60.2%）是小细胞癌（SCC）。NEPC 的年龄调整发病率在研究期间显著增加。然而，这种增加仅影响 SCC（从 2004 年的 0.13/100 万人口年到 2013 年的 0.30/100 万人口年；P=0.001）。NEPC 的中位生存时间为 10 个月。按转移状态分层后，SCC 与非 SCC 之间没有差异。在非转移性疾病患者中，根治性前列腺切除术可改善 OS，而放射治疗对 OS 率没有影响。在多变量 Cox 回归分析中，预测总死亡率的因素包括转移阶段（危险比，1.52；95%置信区间，1.12-2.06；P<0.01）和根治性前列腺切除术（危险比，0.38；95%置信区间，0.20-0.74；P<0.01），两者均为独立预测因素。
原发性 NEPC 极为罕见，很少有泌尿科医生在临床实践中遇到。大多数病例在诊断时就已经转移。无论组织学类型如何，预后都很差，尤其是在转移阶段。
