Bakarev M A, Levin V P, Kachesov I V, Neimark A I
Institute of Molecular Pathology and Morphopathology, Novosibirsk, Russia.
Altai State Medical University, Ministry of Health of the Russia, Barnaul, Russia.
Arkh Patol. 2018;80(3):26-33. doi: 10.17116/patol201880326-33.
To investigate structural changes in the tumor and nontumor tissues of the prostate in patients with its cancer (PC) after treatment with high-intensity focused ultrasound (HIFU) in combination with androgen deprivation to clarify criteria for evaluating the efficiency of treatment.
Comparative morphological, immunohistochemical, and morphometric analyses were carried out to examine 253 pre- and postoperative biopsy specimens, as well as transurethral resection specimens from 32 patients with localized PC and with or without a local recurrence within 3 years after a HIFU session.
HIFU ablation was accompanied by coagulation necrosis and progressive pancreatic fibrosis with complete tumor regression or by a reduction in the number of positive columns (by an average of 58%) in cases with recurrence. An inverse relationship was found between the degree of a reduction in the nontumor parenchyma in the control specimens and the probability of a recurrence - a less than 20% reduction in the non-tumor glands corresponded to a 3.4-fold increased risk of tumor progression. The development of recurrence was associated with less differentiated PC (GS ≥4+3) and the presence of cribriform structures in the pretreatment samples. Combined androgen deprivation as the maximum blockade was associated with the most pronounced signs of therapeutic pathomorphism, with a reduction of the microcirculatory bed in the focus of residual tumor, and a decrease in the frequency of local progression.
Neoadjuvant hormone therapy contributes to the enhanced efficiency of HIFU treatment for PC. A less than 20% reduction in nontumor parenchyma volumes in the control biopsy specimens may indicate insufficient ablation in pancreatic tissue and serve as a marker for increased risk of local progression.
研究高强度聚焦超声（HIFU）联合雄激素剥夺治疗前列腺癌（PC）患者后，其肿瘤组织和非肿瘤组织的结构变化，以明确治疗效果评估标准。
对32例局限性PC患者在HIFU治疗前、后的活检标本以及经尿道切除标本进行比较形态学、免疫组织化学和形态计量学分析，这些患者在HIFU治疗后3年内有或无局部复发。
HIFU消融伴有凝固性坏死和进行性胰腺纤维化，肿瘤完全消退；或在复发病例中阳性柱数量减少（平均减少58%）。在对照标本中，非肿瘤实质减少程度与复发概率呈负相关——非肿瘤腺体减少少于20%对应肿瘤进展风险增加3.4倍。复发的发生与低分化PC（GS≥4+3）以及预处理样本中筛状结构的存在有关。联合雄激素剥夺作为最大阻断与最明显的治疗病理形态学征象相关，残余肿瘤灶内微循环床减少，局部进展频率降低。
新辅助激素治疗有助于提高HIFU治疗PC的疗效。对照活检标本中非肿瘤实质体积减少少于20%可能表明胰腺组织消融不足，并可作为局部进展风险增加的标志物。
