Gagnon Richard, Kish Ealia Khosh, Cook Sarah, Takemura Kosuke, Cheng Brian Yu Chieh, Bressler Kamiko, Heng Daniel Yick Chin, Alimohamed Nimira, Ruether Dean, Lee-Ying Richard Marvin, Bose Pinaki, Kolinsky Michael Paul, Vasquez Catalina, Samuel Divya, Lewis John, Faridi Rehan, Borkar Minal, Fairey Adrian, Bismar Tarek, Yip Steven
Tom Baker Cancer Centre, Calgary, Alberta, Canada.
University of Calgary, Calgary, Alberta, Canada.
Clin Genitourin Cancer. 2025 Feb;23(1):102274. doi: 10.1016/j.clgc.2024.102274. Epub 2024 Nov 23.
Neuroendocrine prostate cancer (NEPC) encompasses pure NEPC and tumors with mixed adenocarcinoma and neuroendocrine histology. While NEPC is thought to confer a poor prognosis, outcome data are sparse, making risk stratification and treatment decisions difficult for clinicians.
This retrospective study identified patients with morphological and/or immunohistochemical NEPC features on pathological review of high-grade prostate cancer cases. Median overall survival (OS) was calculated by stage and castration sensitivity. Prognostic factors were assessed via multivariate analysis. OS and progression-free survival on first-line metastatic systemic treatment were also evaluated.
Of 135 NEPC cases, 25.9% had NEPC documented in the original pathological report. Mixed pathology was found in 91.9% of cases. Median OS from NEPC diagnosis was 59.2, 42.3, 14.3, 17.6 and 9.6 months for localized, nonmetastatic castration-sensitive, nonmetastatic castration-resistant, metastatic castration-sensitive and metastatic castration-resistant prostate cancer, respectively. Anemia (hazard ratio [HR]: 1.66; 95% CI 1.05-2.16; P = .031) and elevated neutrophil-lymphocyte ratio (NLR) (HR: 1.51; 95% CI 1.01-2.52; P = .045), were associated with increased risk of death on multivariate analysis. 67 patients received first-line metastatic treatment beyond androgen deprivation, with a median progression-free survival of 5.2 months and OS of 15 months. Of these, 50.7% received more than 1 line of systemic treatment.
We observed underdiagnosis of NEPC in pathology specimens. NEPC is associated with poorer prognosis than would be expected in pure adenocarcinoma populations, with rapid progression on first-line metastatic treatment and sharp drop-off between subsequent treatment lines. Anemia and elevated NLR were associated with poor survival.
神经内分泌前列腺癌（NEPC）包括纯NEPC以及具有腺癌和神经内分泌混合组织学特征的肿瘤。虽然NEPC被认为预后较差，但相关结局数据稀少，这使得临床医生难以进行风险分层和制定治疗决策。
这项回顾性研究在对高级别前列腺癌病例进行病理检查时，识别出具有形态学和/或免疫组化NEPC特征的患者。通过分期和去势敏感性计算中位总生存期（OS）。通过多变量分析评估预后因素。还评估了一线转移性全身治疗的OS和无进展生存期。
在135例NEPC病例中，25.9%在原始病理报告中有NEPC记录。91.9%的病例存在混合病理。从NEPC诊断开始计算的中位OS，局限性、非转移性去势敏感、非转移性去势抵抗、转移性去势敏感和转移性去势抵抗前列腺癌分别为59.2、42.3、14.3、17.6和9.6个月。多变量分析显示，贫血（风险比[HR]：1.66；95%置信区间1.05 - 2.16；P = 0.031）和中性粒细胞与淋巴细胞比值（NLR）升高（HR：1.51；95%置信区间1.01 - 2.52；P = 0.045）与死亡风险增加相关。67例患者接受了雄激素剥夺以外的一线转移性治疗，中位无进展生存期为5.2个月，OS为15个月。其中，50.7%接受了超过1线的全身治疗。
我们观察到病理标本中NEPC存在诊断不足的情况。NEPC的预后比纯腺癌人群预期的更差，一线转移性治疗进展迅速，后续治疗线之间急剧下降。贫血和NLR升高与生存不良相关。
