Ohori M, Scardino P T, Lapin S L, Seale-Hawkins C, Link J, Wheeler T M
Matsunaga-Conte Prostate Cancer Research Center, Baylor College of Medicine, Houston, Texas 77030.
Am J Surg Pathol. 1993 Dec;17(12):1252-61. doi: 10.1097/00000478-199312000-00006.
To assess the mechanisms and prognostic significance of seminal vesicle involvement (SVI) by prostatic adenocarcinoma, we analyzed 312 radical prostatectomy specimens obtained from patients with T1-T3 prostate cancer. Detailed pathological examination demonstrated three patterns of SVI. Type I involvement was direct spread along the ejaculatory duct complex into the seminal vesicles. Type II involvement was spread outside of the prostate, through the capsule, and then into the seminal vesicle. Type III involvement was characterized by the finding of isolated deposits of cancer in the seminal vesicle with no contiguous primary cancer in the prostate. We found SVI in 64 patients (21%), who have been followed for a mean of 31 months (range 1-101). A defining criterion for progression was clinically apparent local or distant recurrence or a postoperative serum prostate specific antigen (PSA) > or = 0.4 ng/ml (Hybritech). Type I SVI was found in 17 (26%), Type II in 21 (33%), and Type III in 8 (13%) cases. In 18 patients (28%), the pattern of SVI appeared to be a combination of types I and II (categorized as Type I+II). Type III (isolated metastasis) SVI was associated with significantly smaller cancers (median, 3.13 vs. 6.7 cc; p < 0.0005) and fewer positive margins (0 vs. 32%; p = 0.05) than in other types. Type II SVI, with direct extension through the capsule, was associated with a significantly higher risk of lymph node metastasis (8 vs. 33%; p < 0.05). When patients with lymph node metastases were excluded, there was a trend toward a more favorable prognosis (p = 0.09) for patients with type III SVI than with other types. Overall, patients with type III SVI had a progression-free survival rate similar to that of 83 patients with extracapsular extension without SVI. We conclude that the prognostic significance of SVI may not be uniformly ominous; instead, it may depend on the specific mechanism of involvement and the pathologic features of the primary tumor.
为评估前列腺腺癌侵犯精囊（SVI）的机制及预后意义，我们分析了312例接受根治性前列腺切除术的T1 - T3期前列腺癌患者的标本。详细的病理检查显示SVI有三种模式。I型侵犯是沿射精管复合体直接蔓延至精囊。II型侵犯是癌组织穿出前列腺包膜，蔓延至精囊。III型侵犯的特征是在精囊中发现孤立的癌灶，而前列腺内无相邻的原发癌灶。我们在64例患者（21%）中发现了SVI，这些患者平均随访31个月（范围1 - 101个月）。进展的定义标准为临床上出现明显的局部或远处复发，或术后血清前列腺特异性抗原（PSA）≥0.4 ng/ml（Hybritech法）。I型SVI见于17例（26%），II型见于21例（33%），III型见于8例（13%）。18例患者（28%）的SVI模式似乎为I型和II型的组合（归类为I + II型）。与其他类型相比，III型（孤立转移）SVI与明显较小的肿瘤（中位数，3.13 vs. 6.7 cc；p < 0.0005）及较少的切缘阳性（0 vs. 32%；p = 0.05）相关。II型SVI因直接穿透包膜，与淋巴结转移的风险显著较高相关（8% vs. 33%；p < 0.05）。当排除有淋巴结转移的患者后，III型SVI患者的预后有比其他类型更有利的趋势（p = 0.09）。总体而言，III型SVI患者的无进展生存率与83例有包膜外侵犯但无SVI的患者相似。我们得出结论，SVI的预后意义可能并非一律不佳；相反，它可能取决于具体的侵犯机制及原发肿瘤的病理特征。
