Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Prostate. 2019 Sep;79(13):1563-1571. doi: 10.1002/pros.23878. Epub 2019 Aug 2.
The rarities of primary neuroendocrine prostate cancer (NEPC) and primary adenocarcinoma with neuroendocrine differentiation (NE differentiation) mean that their clinical characteristics have not been fully elucidated.
A total of 449 patients with NEPC, including 352 cases of pure NEPC and 97 cases of NE differentiation, together with 408 629 cases of prostate adenocarcinoma at diagnosis were retrieved from the Surveillance, Epidemiology, and End Results program (2010-2015). Clinical parameters and prognoses were compared between patients with different histological types of NEPC using the χ test and Kaplan-Meier analysis, respectively. The prognostic value of prostate-specific antigen (PSA) in NEPC and adenocarcinoma was evaluated using Cox regression and the Kaplan-Meier method.
Pure NEPC had higher rates of visceral metastases (brain, lung, and liver: 4.58%, 26.72%, and 36.64%, respectively) but a lower rate of bone metastasis (65.65%) compared with NE differentiation and prostate adenocarcinoma. Moreover, patients diagnosed with pure NEPC had a poorer outcome (median survival time: 10 months) compared with patients with NE differentiation (26 months) and prostate adenocarcinoma (median survival time not reached). Using PSA 4.1 to 10 ng/mL as the reference, the adjusted hazard ratios (HRs) for PSA lower than or equal to 4.0 ng/mL were 2.24 (95% confidence interval [CI]: 1.11-4.55, P = .025) in the NE differentiation group and 1.57 (95% CI: 1.11-2.23, P = .011) in the pure NEPC group.
Patients with NE differentiation had different clinical characteristics and a better prognosis than patients with pure NEPC. In addition, low-serum PSA levels were associated with a poorer prognosis in patients with either NEPC or NE differentiation.
原发性神经内分泌前列腺癌（NEPC）和原发性伴神经内分泌分化的腺癌（NE 分化）较为罕见，因此其临床特征尚未完全阐明。
本研究共纳入 449 例 NEPC 患者，其中 352 例为纯 NEPC，97 例为 NE 分化，同时纳入 408629 例前列腺腺癌患者，所有患者均来自监测、流行病学和最终结果（SEER）计划数据库（2010-2015 年）。采用卡方检验和 Kaplan-Meier 分析比较不同组织学类型的 NEPC 患者的临床参数和预后，采用 Cox 回归和 Kaplan-Meier 方法评估前列腺特异性抗原（PSA）在 NEPC 和腺癌中的预后价值。
与 NE 分化和前列腺腺癌相比，纯 NEPC 患者发生内脏转移（脑、肺和肝）的比例更高（分别为 4.58%、26.72%和 36.64%），但发生骨转移的比例较低（65.65%）。此外，与 NE 分化患者（26 个月）和前列腺腺癌患者（中位生存时间未达到）相比，纯 NEPC 患者的预后更差（中位生存时间为 10 个月）。以 PSA 4.1-10ng/ml 为参考，PSA 低于或等于 4.0ng/ml 的调整后危险比（HR）在 NE 分化组为 2.24（95%置信区间[CI]：1.11-4.55，P=0.025），在纯 NEPC 组为 1.57（95% CI：1.11-2.23，P=0.011）。
与纯 NEPC 患者相比，NE 分化患者具有不同的临床特征和更好的预后。此外，无论是 NEPC 还是 NE 分化患者，低血清 PSA 水平均与预后不良相关。
