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目的探讨前列腺小细胞性神经内分泌癌的临床病理学特征及治疗方法。方法报告3例经病理明确诊断的前列腺小细胞性神经内分泌癌,并复习同期国内报道的23例神经内分泌癌的临床及病理学资料,采用统计学方法分析患者的整体生存率及临床、病理特征与患者生存期的关系。结果 26例患者年龄21～82岁,平均59岁。血清PSA水平20例正常,6例升高。病理学检查21例为单纯性,5例为混合性。12例进行了内分泌治疗,10例行化疗,2例行放疗。确诊时12例伴周围组织或脏器侵犯,8例有淋巴、血管侵犯,9例有远隔脏器的转移。最长随访时间为17个月,截至随访时16例死亡,8例生存,2例失访;中位生存时间为8个月,1年生存率为23.2%。统计学分析结果显示化疗与否与患者生存时间关系密切(P<0.05),而血清PSA水平、手术方式、组织学类型、局部侵犯、淋巴血管侵犯及远隔转移与患者生存时间无相关性(P>0.05)。结论前列腺小细胞性神经内分泌癌恶性程度高,预后很差。确诊主要依靠病理学检查,单纯性患者血清PSA往往不升高;手术与否、是否混合有腺泡腺癌成分以及临床分期均与预后无关;化疗是前列腺小细胞性神经内分泌癌的唯一预后相关因素,对于术前穿刺病理提示为该病的患者,将化疗作为一线治疗可能会提高疗效。
Objective To investigate the clinicopathological features and treatment of prostatic small cell neuroendocrine carcinoma. Methods Three cases of small cell neuroendocrine carcinoma diagnosed by pathology were reported. The clinical and pathological data of 23 cases of neuroendocrine carcinoma reported in China during the same period were reviewed. The overall survival rate, clinical and pathological features were analyzed by using statistical methods Relationship with patient survival. Results 26 patients aged 21 to 82 years, mean 59 years. Serum PSA levels were normal in 20 cases and elevated in 6 cases. 21 cases of pathological examination was simple, 5 were mixed. Endocrine therapy was performed in 12 cases, chemotherapy in 10 cases and radiotherapy in 2 cases. Confirmed when 12 cases with peripheral tissue or organ invasion, 8 cases of lymphatic, vascular invasion, 9 cases of distant organs metastasis. The longest follow-up time was 17 months. Up to the follow-up, 16 patients died, 8 survived and 2 lost follow-up. The median survival time was 8 months and the 1-year survival rate was 23.2%. The results of statistical analysis showed that there was a close relationship between chemotherapy and survival time (P <0.05), but there was no correlation between serum PSA level, operation method, histological type, local invasion, lymphatic invasion and distant metastasis P> 0.05). Conclusion Prostatic small cell neuroendocrine carcinoma is highly malignant with poor prognosis. Diagnosis depends mainly on pathological examination, simple serum PSA is often not increased; surgery or not, mixed with acinar adenocarcinoma and clinical stage have nothing to do with the prognosis; chemotherapy is the only prognosis of prostate small cell neuroendocrine cancer Factors, preoperative puncture pathology prompted for the disease patients, chemotherapy as a first-line treatment may improve the curative effect.