Reeves Fairleigh A, Battye Shane, Roth Hedley, Peters Justin S, Hovens Christopher, Costello Anthony J, Corcoran Niall M
Department of Surgery, Division of Urology, University of Melbourne, Royal Melbourne Hospital, Australia; Urology Unit, Department of Surgery, Peninsula Health, Australia.
TissuPath Pty Ltd, Mount Waverley, Australia.
J Clin Neurosci. 2019 May;63:213-219. doi: 10.1016/j.jocn.2019.01.052. Epub 2019 Feb 13.
To describe nerve subtypes involved by perineural invasion (PNI) in prostate cancer and their relationship with clinicopathological parameters and recurrence risk.
141 prostatectomy specimens from men with localized prostate cancer and known perineural invasion were analyzed. Index tumor blocks were stained for perineural invasion and sympathetic/parasympathetic markers. For 98 patients with complete staining, nerves from up to three hotspot regions of intraprostatic perineural invasion were classified according to autonomic subtype and perineural invasion status. Findings were correlated with prospectively collected clinicopathological data. Biochemical recurrence predictors were tested in univariable and multivariable models.
Most intra-prostatic nerves contained sympathetic and parasympathetic fibres, irrespective of perineural invasion status. A fraction was purely sympathetic (5% PNI, 2% non-PNI) or double-negative (non-adrenergic, non-nitrergic; 1% PNI, 1% non-PNI). Perineural invasion nerve count was associated with higher pathological stage. Although total perineural invasion or non-perineural invasion nerve count did not predict biochemical recurrence, two subtypes were found to be independent predictors: pure sympathetic non-perineural invasion nerves (HR 6.79, p = 0.03) and non-adrenergic, non-nitrergic PNI nerves (HR 10.56, p < 0.005).
Pure sympathetic nerve density without tumour invasion and perineural invasion specifically involving non-adrenergic, non-nitrergic fibres are independent predictors of biochemical recurrence post prostatectomy, supporting a role for the autonomic nervous system in prostate cancer progression.
描述前列腺癌中发生神经周围侵犯（PNI）的神经亚型及其与临床病理参数和复发风险的关系。
分析了141例患有局限性前列腺癌且已知存在神经周围侵犯的男性患者的前列腺切除标本。对索引肿瘤块进行神经周围侵犯和交感/副交感神经标志物染色。对于98例染色完整的患者，根据自主神经亚型和神经周围侵犯状态，对前列腺内神经周围侵犯的多达三个热点区域的神经进行分类。研究结果与前瞻性收集的临床病理数据相关。在单变量和多变量模型中测试生化复发预测因素。
无论神经周围侵犯状态如何，大多数前列腺内神经都含有交感和副交感神经纤维。一小部分是纯交感神经（5% PNI，2% 非PNI）或双阴性（非肾上腺素能、非一氧化氮能；1% PNI，1% 非PNI）。神经周围侵犯神经计数与更高的病理分期相关。尽管总的神经周围侵犯或非神经周围侵犯神经计数不能预测生化复发，但发现两种亚型是独立的预测因素：纯交感神经非神经周围侵犯神经（HR 6.79，p = 0.03）和非肾上腺素能、非一氧化氮能PNI神经（HR 10.56，p < 0.005）。
无肿瘤侵犯的纯交感神经密度以及特异性涉及非肾上腺素能、非一氧化氮能纤维的神经周围侵犯是前列腺切除术后生化复发的独立预测因素，支持自主神经系统在前列腺癌进展中的作用。
