Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Surgical Pathology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Japan.
Cancer Sci. 2022 Jul;113(7):2425-2433. doi: 10.1111/cas.15392. Epub 2022 May 19.
The clinical significance of intraductal carcinoma of the prostate (IDC-P) in men with nonmetastatic prostate cancer (PCa) treated with high-dose external-beam radiation therapy remains unclear. The aim of this study was to evaluate the impact of IDC-P in men who received intensity-modulated radiation therapy (IMRT) for nonmetastatic PCa. All patients with high-risk (H-R) and very high-risk (VH-R) PCa who received IMRT between September 2000 and December 2013 at our institution were analyzed retrospectively. We re-reviewed biopsy cores for the presence of IDC-P. Treatment consisted of IMRT (median: 78 Gy at 2 Gy per fraction) plus 6-month neoadjuvant hormonal therapy (HT). In total, 154 consecutive patients with H-R and VH-R PCa were analyzed. Intraductal carcinoma of the prostate was present in 27.9% (n = 43). The median follow-up period was 8.4 years. The 10-year PCa-specific survival, biochemical failure (BF), clinical failure, and castration-resistant PCa rates were 90.0%, 47.8%, 27.5%, and 24.5% in patients with IDC-P, and 96.6%, 32.6%, 10.8%, and 7.0% in those without IDC-P, respectively (p = 0.12, 0.04, 0.0031, and 0.012, respectively). In multivariable analysis, IDC-P was not identified as an independent predictive factor for BF (p = 0.26). The presence of IDC-P was correlated with a significantly higher incidence of disease progression in men with H-R and VH-R PCa who received IMRT, although it was not identified as an independent predictive factor for BF. Further investigations are needed to determine the significance of IDC-P as an independent predictive factor for survival outcomes.
前列腺管内癌（IDC-P）在接受高剂量外照射治疗的非转移性前列腺癌（PCa）男性中的临床意义尚不清楚。本研究旨在评估 IDC-P 对接受非转移性 PCa 调强放疗（IMRT）的男性的影响。回顾性分析了 2000 年 9 月至 2013 年 12 月在我院接受 IMRT 的所有高危（H-R）和极高危（VH-R）PCa 患者。我们重新检查了活检标本中是否存在 IDC-P。治疗包括 IMRT（中位数：2Gy/次，78Gy）加 6 个月的新辅助激素治疗（HT）。共分析了 154 例 H-R 和 VH-R PCa 连续患者。IDC-P 存在于 27.9%（n=43）的患者中。中位随访时间为 8.4 年。IDC-P 患者的 10 年 PCa 特异性生存率、生化失败（BF）、临床失败和去势抵抗性 PCa 发生率分别为 90.0%、47.8%、27.5%和 24.5%，而无 IDC-P 患者分别为 96.6%、32.6%、10.8%和 7.0%（p=0.12、0.04、0.0031 和 0.012）。多变量分析显示，IDC-P 不是 BF 的独立预测因素（p=0.26）。在接受 IMRT 的 H-R 和 VH-R PCa 男性中，IDC-P 的存在与疾病进展的发生率显著相关，但未被确定为 BF 的独立预测因素。需要进一步研究以确定 IDC-P 作为独立预测因素对生存结果的意义。
