De Bari Berardino, Stish Bradley, Ball Mark Wayne, Habboush Yacob, Sargos Paul, Krengli Marco, Bossi Alberto, Stabile Armando, Sole Pesutic Claudio, Lestrade Laëtitia, Smeenk Robert Jan, Jereczek-Fossa Barbara Alicja, Zilli Thomas, Créhange Gilles, Alongi Filippo, Zaorsky Nicholas, Ozsahin Mahmut
Department of Radiation Oncology, Centre Hospitalier Régional Universitaire "Jean Minjoz", INSERM, UMR1098, Besançon, France.
Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Prostate. 2017 Jul;77(10):1160-1166. doi: 10.1002/pros.23375. Epub 2017 Jun 8.
Adult prostatic sarcoma (PS) is a rare disease. While surgery is considered the standard approach, the role of other therapies is not completely established. We report results of the largest multicentric contemporary cohort of PS patients.
This study included 61 adult PS patients treated in 16 American and European Institutions. Median age was 64.4 years (range: 22-87). Curative surgery was delivered in 48 patients (prostatectomy = 26, cystoprostatectomy = 22), usually with lymphadenectomy (n = 40). Curative radiotherapy (RT) was delivered in 32 patients, as radical (n = 5), neoadjuvant (n = 10), or postoperative treatment (n = 17). Eighteen patients received chemotherapy. None of the patients received hormonal therapy.
Median follow-up was 72 months (95%CI: 55-not reached). Five-year local control (LC), overall survival (OS), cancer-specific survival, disease-free survival, and metastases-free rates were 47%, 53%, 56%, 35%, and 35%, respectively. Notably, curative RT (neoadjuvant, adjuvant, or definitive) was associated with improved 5-year LC (55% vs. 31%, P = 0.02) and OS (59% vs. 46%, P = 0.1). Surgically treated patients presenting with a cT3-4 tumor (n = 31), who received RT (n = 24), had a significantly improved 5-year LC (68% vs, 33%, P = 0.004) and OS (65% vs. 21%, P < 0.001) rates compared to patients not receiving RT. cT4 patients demonstrated a significantly lower 5-year OS (43% vs. 61%, P = 0.006) and LC (29% vs. 69%, P < 0.001) rates. Histologic subtype was not associated with LC and OS, but patients with prostatic stromal sarcoma, rhabdomyosarcoma, or sarcomatoid carcinoma had worse 5-year LC compared to other types (47% vs. 55%) and OS (49% vs. 58%).
Adult PS has a poor prognosis. Locally advanced tumors have poor LC and OS rates. Curative RT should be considered part of the multidisciplinary approach to PS.
成人前列腺肉瘤（PS）是一种罕见疾病。虽然手术被认为是标准治疗方法，但其他治疗方法的作用尚未完全明确。我们报告了最大规模的当代多中心PS患者队列研究结果。
本研究纳入了在美国和欧洲16家机构接受治疗的61例成年PS患者。中位年龄为64.4岁（范围：22 - 87岁）。48例患者接受了根治性手术（前列腺切除术 = 26例，膀胱前列腺切除术 = 22例），通常还进行了淋巴结清扫术（n = 40）。32例患者接受了根治性放疗（RT），包括根治性放疗（n = 5）、新辅助放疗（n = 10）或术后放疗（n = 17）。18例患者接受了化疗。所有患者均未接受激素治疗。
中位随访时间为72个月（95%CI：55 - 未达到）。5年局部控制率（LC）、总生存率（OS）、癌症特异性生存率、无病生存率和无转移率分别为47%、53%、56%、35%和35%。值得注意的是，根治性放疗（新辅助、辅助或根治性）与5年LC改善相关（55%对31%，P = 0.02）和OS改善相关（59%对46%，P = 0.1）。接受RT（n = 24）的cT3 - 4期手术治疗患者（n = 31），其5年LC（68%对33%，P = 0.004）和OS（65%对21%，P < 0.001）率显著高于未接受RT的患者。cT4期患者的5年OS（43%对61%，P = 0.006）和LC（29%对69%，P < 0.001）率显著更低。组织学亚型与LC和OS无关，但前列腺间质肉瘤、横纹肌肉瘤或肉瘤样癌患者的5年LC（47%对55%）和OS（49%对58%）较其他类型更差。
成人PS预后较差。局部晚期肿瘤的LC和OS率较低。根治性RT应被视为PS多学科治疗方法的一部分。
