Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan.
Wayne State University School of Medicine, Detroit, Michigan.
J Urol. 2020 Aug;204(2):260-266. doi: 10.1097/JU.0000000000001011. Epub 2020 Mar 6.
The American Joint Committee on Cancer recognizes 6 rare histological variants of prostate adenocarcinoma. We describe the contemporary presentation and overall survival of these rare variants.
We examined 1,345,618 patients who were diagnosed with prostate adenocarcinoma between 2004 and 2015 within the National Cancer Database. We focused on the variants mucinous, ductal, signet ring cell, adenosquamous, sarcomatoid and neuroendocrine. Characteristics at presentation for each variant were compared with nonvariant prostate adenocarcinoma. Cox regression was used to study the impact of histological variant on overall mortality.
Few (0.38%) patients presented with rare variant prostate adenocarcinoma. All variants had higher clinical tumor stage at presentation than nonvariant (all p <0.001). Metastatic disease was most common with neuroendocrine (62.9%), followed by sarcomatoid (33.3%), adenosquamous (31.1%), signet ring cell (10.3%) and ductal (9.8%), compared to 4.2% in nonvariant (all p <0.001). Metastatic disease in mucinous (3.3%) was similar to nonvariant (p=0.2). Estimated 10-year overall survival was highest in mucinous (78.0%), followed by nonvariant (71.1%), signet ring cell (56.8%), ductal (56.3%), adenosquamous (20.5%), sarcomatoid (14.6%) and neuroendocrine (9.1%). At multivariable analysis, mortality was higher in ductal (HR 1.38, p <0.001), signet ring cell (HR 1.53, p <0.01), neuroendocrine (HR 5.72, p <0.001), sarcomatoid (HR 5.81, p <0.001) and adenosquamous (HR 9.34, p <0.001) as compared to nonvariant.
Neuroendocrine, adenosquamous, sarcomatoid, signet ring cell and ductal variants more commonly present with metastases. All variants present with higher local stage than nonvariant. Neuroendocrine is associated with the worst and mucinous with the best overall survival.
美国癌症联合委员会（AJCC）认可了 6 种前列腺腺癌的罕见组织学变异型。我们描述了这些罕见变异型的当代表现和总体生存率。
我们在国家癌症数据库中检查了 2004 年至 2015 年间诊断为前列腺腺癌的 1345618 名患者。我们专注于黏液性、管状、印戒细胞、腺鳞癌、肉瘤样和神经内分泌变异型。比较了每种变异型在就诊时的特征与非变异型前列腺腺癌。使用 Cox 回归研究组织学变异型对总死亡率的影响。
只有少数（0.38%）患者表现为罕见的变异型前列腺腺癌。所有变异型在就诊时的临床肿瘤分期均高于非变异型（均 p<0.001）。神经内分泌型（62.9%）最常见转移性疾病，其次是肉瘤样型（33.3%）、腺鳞癌（31.1%）、印戒细胞癌（10.3%）和管状型（9.8%），而非变异型为 4.2%（均 p<0.001）。黏液性（3.3%）的转移性疾病与非变异型相似（p=0.2）。估计 10 年总生存率在黏液型最高（78.0%），其次是非变异型（71.1%）、印戒细胞癌（56.8%）、管状型（56.3%）、腺鳞癌（20.5%）、肉瘤样型（14.6%）和神经内分泌型（9.1%）。多变量分析显示，管状型（HR 1.38，p<0.001）、印戒细胞癌（HR 1.53，p<0.01）、神经内分泌型（HR 5.72，p<0.001）、肉瘤样型（HR 5.81，p<0.001）和腺鳞癌（HR 9.34，p<0.001）的死亡率均高于非变异型。
神经内分泌型、腺鳞癌、肉瘤样型、印戒细胞癌和管状型变异型更常出现转移。所有变异型的局部分期均高于非变异型。神经内分泌型与最差的总体生存率相关，而黏液型与最好的总体生存率相关。
