初诊转移性前列腺癌患者神经周围侵犯的临床意义。

The clinical significance of perineural invasion in patients with de novo metastatic prostate cancer.

机构信息

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.

Department of Pathology, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Andrology. 2019 Mar;7(2):184-192. doi: 10.1111/andr.12578. Epub 2019 Jan 4.

DOI:10.1111/andr.12578

PMID:30609313

Abstract

BACKGROUND

The clinical value of perineural invasion (PNI) in patients with localized prostate cancer (PCa) is widely explored. However, its role in metastatic PCa (mPCa) remains unknown.

OBJECTIVES

We aim to investigate the clinical significance of PNI in patients with mPCa.

MATERIALS AND METHODS

Data of 515 mPCa patients between 2012 and 2018 were retrospectively studied. PNI and its intensity were identified by prostate biopsy. The prognostic value of PNI was evaluated by Kaplan-Meier curves and Cox proportional-hazards model.

RESULTS

Perineural invasion was detected in 170/515 (33.0%) cases. Among them 73/170 (42.9%) and 97/170 (57.1%) harbored unifocal PNI (uni-PNI) and multifocal PNI (multi-PNI), respectively. Compared to patients without PNI, those with PNI had statistically shorter castration-resistant PCa-free survival (CFS) and numerically shorter overall survival (OS) (mCFS: 15.4- vs. 18.5-Mo, p = 0.015; mOS: 63.8- vs. 71.4-Mo, p = 0.108). Patients harboring multi-PNI were associated with poorer clinical outcomes than those with uni-PNI (mCFS: 12.4- vs. 18.0-Mo, p = 0.040; mOS: 39.7-Mo vs. NR, p = 0.018) or those without PNI (mCFS: 12.4- vs. 18.5-Mo, p = 0.002; mOS: 39.7- vs. 71.4-Mo, p = 0.002). Totally, neither uni-PNI nor multi-PNI was an independent risk factor impacting survival outcomes in multivariate analyses. While remarkably, for patients with favorable/intermediate-risk mPCa, multi-PNI was an independent adverse prognosticator for both CFS and OS (CFS: HR: 1.705, 95% CI: 1.029-2.825, p = 0.038; OS: HR: 3.294, 95% CI: 1.464-7.413, p = 0.004).

DISCUSSION AND CONCLUSION

This study filled the blank of the clinical significance of PNI in mPCa. We found that multi-PNI could distinguish men with relatively poor prognosis from patients initially regarded as with favorable survival outcomes by other prognosticators, and thus, avoid disease underestimation in this group of patients. Our finding would help physicians have a deeper understanding of the heterogeneity of mPCa and make better individualized therapeutic strategy.

摘要

背景

神经周围侵犯（PNI）在局限性前列腺癌（PCa）患者中的临床价值已被广泛研究。然而，其在转移性 PCa（mPCa）中的作用仍不清楚。

目的

我们旨在探讨 PNI 在 mPCa 患者中的临床意义。

材料与方法

回顾性分析了 2012 年至 2018 年间 515 例 mPCa 患者的数据。通过前列腺活检确定 PNI 及其强度。采用 Kaplan-Meier 曲线和 Cox 比例风险模型评估 PNI 的预后价值。

结果

515 例 mPCa 患者中，170 例（33.0%）检测到 PNI。其中 73 例（42.9%）和 97 例（57.1%）为单灶 PNI（uni-PNI）和多灶 PNI（multi-PNI）。与无 PNI 患者相比，有 PNI 的患者无去势抵抗性前列腺癌生存（CFS）更短，总生存（OS）更短（mCFS：15.4-vs.18.5-Mo，p=0.015；mOS：63.8-vs.71.4-Mo，p=0.108）。与 uni-PNI 或无 PNI 相比，multi-PNI 患者的临床结局更差（mCFS：12.4-vs.18.0-Mo，p=0.040；mOS：39.7-Mo vs. NR，p=0.018）。总的来说，uni-PNI 或 multi-PNI 均不是多变量分析中影响生存结果的独立危险因素。然而，有趣的是，对于预后良好/中度危险的 mPCa 患者，multi-PNI 是 CFS 和 OS 的独立不良预后因素（CFS：HR：1.705，95%CI：1.029-2.825，p=0.038；OS：HR：3.294，95%CI：1.464-7.413，p=0.004）。