Wänman Johan, Abul-Kasim Kasim, Semenas Julius, Thysell Elin, Bergh Anders, Wikström Pernilla, Crnalic Sead
Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden.
Division of Neuroradiology, Diagnostic Centre for Imaging and Functional Medicine, Faculty of Medicine, Lund University, Skåne University Hospital, Lund, Sweden.
Eur Urol Open Sci. 2022 Dec 26;48:44-53. doi: 10.1016/j.euros.2022.12.004. eCollection 2023 Feb.
Prostate cancer spinal bone metastases can have a radiographic profile that mimics multiple myeloma.
To analyse the presence and prognostic value of myeloma-like prostate cancer bone metastases and its relation to known clinical, molecular, and morphological prognostic markers.
A cohort of 110 patients with prostate cancer who underwent surgery for metastatic spinal cord compression (MSCC) was analysed. Spinal bone metastases were classified as myeloma like ( = 20) or non-myeloma like ( = 90) based on magnetic resonance imaging prior to surgery. An immunohistochemical analysis of metastasis samples was performed to assess tumour cell proliferation (percentage of Ki67-positive cells) and the expression levels of prostate-specific antigen (PSA) and androgen receptor (AR). The metastasis subtypes MetA, MetB, and MetC were determined from transcriptomic profiling.
Survival curves were compared with the log-rank test. Univariate and multivariate Cox proportional hazard models were used to assess the effects of prognostic variables. Groups were compared using the Mann-Whitney test for continuous variables and the chi-square test for categorical variables.
Patients with the myeloma-like metastatic pattern had median survival after surgery for MSCC of 1.7 (range 0.1-33) mo, while the median survival period of those with the non-myeloma-like pattern was 13 (range 0-140) mo ( < 0.001). The myeloma-like appearance had an independent prognostic value for the risk of death after MSCC surgery (adjusted hazard ratio 2.4, = 0.012). Postoperative neurological function was significantly reduced in the myeloma-like group. No association was found between the myeloma-like pattern and morphological markers of known relevance for this patient group: the transcriptomic subtypes MetA, MetB, and MetC; tumour cell proliferation; and AR and PSA expression.
A myeloma-like metastatic pattern identifies an important subtype of metastatic prostate cancer associated with poor survival and neurological outcomes after surgery for MSCC.
This study describes a novel radiographic pattern of prostate cancer bone metastases and its relation to poor patient prognosis.
前列腺癌脊柱骨转移的影像学表现可能与多发性骨髓瘤相似。
分析骨髓瘤样前列腺癌骨转移的存在情况及其预后价值，以及它与已知临床、分子和形态学预后标志物的关系。
设计、背景与参与者：分析了110例因转移性脊髓压迫（MSCC）接受手术的前列腺癌患者队列。根据术前磁共振成像，将脊柱骨转移分为骨髓瘤样（n = 20）或非骨髓瘤样（n = 90）。对转移样本进行免疫组织化学分析，以评估肿瘤细胞增殖（Ki67阳性细胞百分比）以及前列腺特异性抗原（PSA）和雄激素受体（AR）的表达水平。从转录组分析中确定转移亚型MetA、MetB和MetC。
采用对数秩检验比较生存曲线。使用单变量和多变量Cox比例风险模型评估预后变量的影响。对于连续变量，采用Mann-Whitney U检验比较组间差异；对于分类变量，采用卡方检验比较组间差异。
骨髓瘤样转移模式的患者在MSCC手术后的中位生存期为1.7（范围0.1 - 33）个月，而非骨髓瘤样模式患者的中位生存期为13（范围0 - 140）个月（P < 0.001）。骨髓瘤样表现对MSCC手术后的死亡风险具有独立的预后价值（调整后风险比2.4，P = 0.012）。骨髓瘤样组术后神经功能明显降低。在骨髓瘤样模式与该患者群体已知相关的形态学标志物之间未发现关联：转录组亚型MetA、MetB和MetC；肿瘤细胞增殖；以及AR和PSA表达。
骨髓瘤样转移模式确定了转移性前列腺癌的一种重要亚型，与MSCC手术后的不良生存和神经学结局相关。
本研究描述了前列腺癌骨转移的一种新的影像学模式及其与患者不良预后的关系。
