摘要目的 探讨转移性前列腺癌不同亚组患者中前列腺导管内癌(IDC-P)对患者预后的影响.方法 回顾性分析2011年1月至2017年12月在四川大学华西医院泌尿外科确诊的582例初诊转移性前列腺癌患者的临床资料.年龄(70±8)岁(范围:45～89岁).由两名泌尿病理医师独立进行患者前列腺穿刺标本的病理诊断及IDC-P的检出.采用Kaplan-Meier曲线及多因素Cox回归进行生存分析.采用森林图分析IDC-P在转移性前列腺癌各亚组患者中的预后作用.本研究的结局指标为未进展到去势抵抗性前列腺癌的时间(CFS)和总体生存时间(OS).结果 IDC-P在转移性前列腺癌患者穿刺标本中的检出率为30.4％(177/582).与IDC-P阴性患者相比,IDC-P阳性的转移性前列腺癌患者具有更短的CFS和OS(中位CFS:12.1个月比16.9个月,P=0.000;中位OS:39.7个月比未到达,P=0.000).多因素分析结果显示,IDC-P是转移性前列腺癌患者CFS(HR=1.40,95％CI:1.10～1.79,P=0.006)和OS(HR=1.51,95％CI:1.02～2.25,P=0.041)的独立预后因素.亚组分析结果显示,在绝大多数亚组患者中,IDC-P是患者进展到去势抵抗性前列腺癌和死亡的预后因素.即使是在含有不良临床病理因素的亚组,如Gleason评分9～10分(CFS:HR=1.467,P=0.007;OS:HR=1.807,P=0.013),基线前列腺特异抗原≥50 μg/L(CFS:HR=1.616,P=0.000;OS:HR=1.749,P=0.006)、贫血(CFS:HR=1.653,P=0.036;OS:HR=2.100,P=0.038)、碱性磷酸酶≥160 U/L(CFS:HR=1.326,P=0.038;OS:HR=1.725,P=0.010)或乳酸脱氢酶处于异常范围(CFS:HR=1.614,P=0.001;OS:HR=1.900,P=0.003),IDC-P仍然与的CFS和OS较短相关.结论 IDC-P的检出与转移性前列腺癌患者的不良预后密切相关.在不同患者亚组中,IDC-P均具有较高的预后价值.前列腺穿刺标本病理诊断中对IDC-P的报告将有助于临床医师更准确地评价转移性前列腺癌患者的预后并可能协助制订有效的治疗决策.

abstractsObjective To determine the prognostic value of the intraductal carcinoma of the prostate IDC-P in metastatic prostate cancer (mPCa) patients of different subgroups.Methods Data of 582 de novo mPCa patients between January 2011 and December 2017 diagnosed at Departments of Urology,West China Hospital,Sichuan University were retrospectively analyzed.The age was (70±8) years (range:45 to 89 years).IDC-P was identified from 12-core prostate biopsy.The prognostic role of IDC-P was assessed by Kaplan-Meier curves and Cox regression.Subgroup analysis was conducted by the forest plot.The endpoints were castration-resistant prostate cancer free survival (CFS) and overall survival (OS).Results In total,177/582 (30.4％) patients harbored IDC-P.Patients with IDC-P had poorer CFS and OS than those without IDC-P (mCFS:12.1 months vs.16.9 months,P=0.000;mOS:39.7 months vs.not reached,P=0.000).Multivariate Cox regression analysis indicated that,the existence of IDC-P was an independent prognosticator of both CFS (HR=1.40,95％ CI:1.10 to 1.79,P=0.006) and OS (HR=1.51,95％ CI:1.02 to 2.25,P=0.041).Subanalysis indicated that,in most subgroups,IDC-P was an adverse prognosticator of both CFS and OS.Even in subgroups with adverse clinicopathological features,e.g.Gleason score 9 to 10 (CFS:HR=1.467,P=0.007;OS:HR=1.807,P=0.013),baseline prostate specific antigen≥50 μg/L (CFS:HR=1.616,P=0.000;OS:HR=1.749,P=0.006),anemia (CFS:HR=1.653,P=0.036;OS:HR=2.100,P=0.038),alkaline phosphatase≥160 U / L (CFS:HR=1.326,P=0.038;OS:HR=1.725,P=0.010) or abnormal lactate dehydrogenase level (CFS:HR=1.614,P=0.001;OS:HR=1.900,P=0.003),IDC-P was still closely associated with shorter CFS and OS.Conclusions The presence of IDC-P was closely related to poor survival outcomes for patients with mPCa.IDC-P was an adverse prognosticator in most subgroup patients.The description of IDC-P in the pathological report of prostate biopsy would help clinicians to evaluate the prognosis of mPCa patients more accurately and make better treatment choices.