The presence and clinical implication of intraductal carcinoma of prostate in metastatic castration resistant prostate cancer
The presence and clinical implication of intraductal carcinoma of prostate in metastatic castration resistant prostate cancer
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转移性去势抵抗性前列腺癌中前列腺导管内癌的存在及其临床意义。
DOI：
10.1002/pros.23005
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发表时间：
2015-09-01
期刊：
影响因子：
2.8
通讯作者：
Zeng, Hao
中科院分区：
文献类型：
--
作者：
Chen, Zhibin;Chen, Ni;Zeng, Hao
前列腺癌(IDC-P)一直是前列腺癌中被低估的病理类型，其在耐去势前列腺癌(CRPC)中的作用尚不清楚。本研究旨在探讨IDC-P在转移性前列腺癌中的表达及其意义。所有患者在初诊时和CRPC时均接受了两次经会阴活检。回收所有样本以检测IDC-P的存在。PSA倍增时间(PSADT)被认为是反映CRPC进展的一个参数。结果初诊时IDC-P仅占20%(9/45)，而CRPC时IDC-P占62.5%(28/45)(2=16.568，P=0.000)。与肿瘤组织中的腺样腺癌成分相比，IDC-P成分，特别是实体亚型，对雄激素剥夺治疗(ADT)的反应明显较差或没有反应。此外，在接受多西紫杉醇为主的化疗的患者(n=24)中，接受IDC-P的患者的不良反应也比未接受IDC-P的患者多(20%比66.7%，P=0.022)。CRPC时IDC-P和血清睾酮的存在与疾病的快速进展显著相关。有IDC-P的CRPC患者PSADT<30d者13例(46.4%)，而无IDC-P的CRPC患者仅1/17(5.9%)PSADT<30d(2=8.114，P=0.004)。结论IDC-P的存在与CRPC的快速进展密切相关。它的存在可能表明对最初的ADT和以多西他赛为基础的后续化疗的反应较差。IDC-P的检测在CRPC中具有重要意义，CRPC时再次活检可能是可行的解决方案之一。ADT和多西紫杉醇对IDC-P耐药的机制有待进一步研究。前列腺癌75：1247-1254,2015。(C)2015年威利期刊公司。
BackgroundIntraductal carcinoma of prostate (IDC-P) is always underestimated pathological pattern in prostate cancer and its role is still unclear in castration resistant prostate cancer (CRPC). This study was conducted to investigate the presence and the roles of IDC-P in patients with metastatic CRPC.Methods45 patients with initially diagnosed metastatic prostate cancer and then progressed to CRPC, were included. All of them were received twice transperineal biopsies at the time of initial diagnosis and the time of CRPC. All samples were retrieved to detect the presence of IDC-P. PSA doubling time (PSADT) was considered as a parameter presenting the progression of CRPC. The relationships between IDC-P and other clinicopathological variables were analyzed.ResultsIDC-P was found only in 20% (9/45) cases at initial diagnosis, whereas, it increased to 62.5% (28/45) at the time of CRPC ((2)=16.568, P=0.000). Compared to acinar adenocarcinoma components in tumor tissues, IDC-P components, especially solid subtype, had obviously poor/no response to androgen deprivation therapy (ADT). In addition, among patients treated with docetaxel-based chemotherapy (n=24), patients with IDC-P also showed more unfavorable response than those without IDC-P (20% vs. 66.7%, P=0.022). The presence of IDC-P and serum testosterone at the time of CRPC, were significantly associated with rapid disease progression. 13/28 (46.4%) CRPC with IDC-P had PSADT less than 30 days, while, only 1/17 (5.9%) patient without IDC-P had a less than 30 days PSADT ((2)=8.114, P=0.004). Limitations included the relative short follow-up time and a relative small cohort.ConclusionsThe presence of IDC-P was significantly associated with rapid progression of CRPC. And its presence could suggest the poor response to initial ADT and sequential docetaxel-based chemotherapy. Detection of IDC-P should be of importance in CRPC, and re-biopsy at the time of CRPC might be one of practical solutions. The mechanism of the ADT and docetaxel resistance to IDC-P needed to be further investigated. Prostate 75:1247-1254, 2015. (c) 2015 Wiley Periodicals, Inc.