The clinical significance of perineural invasion in patients with de novo metastatic prostate cancer
The clinical significance of perineural invasion in patients with de novo metastatic prostate cancer
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神经周围侵犯在新发转移性前列腺癌患者中的临床意义
DOI：
10.1111/andr.12578
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发表时间：
2019-03-01
期刊：
影响因子：
4.5
通讯作者：
Zeng, H.
中科院分区：
文献类型：
--
作者：
Zhao, J.;Chen, J.;Zeng, H.
背景局限性前列腺癌(PCa)患者神经侵袭(PNI)的临床价值被广泛探讨。然而，它在转移性前列腺癌(MPCA)中的作用仍不清楚。目的探讨多发性前列腺癌(MPCa)患者PNI的临床意义。材料与方法对2012-2018年间收治的515例MPCA患者的临床资料进行回顾性分析。前列腺活检确定PNI及其强度。应用Kaplan-Meier曲线和Cox比例风险模型评价PNI的预后价值。结果515例中有170例(33.0%)有神经侵犯。其中73/170(42.9%)为单灶性PNI，97/170(57.1%)为多灶性PNI。与无PNI的患者相比，PNI患者的抗去势PCa无生存期(CFS)和总生存期(OS)均较短(MCF15.4Mo vs.18.5Mo，p=0.015；MOS：63.8vs.71.4Mo，p=0.108)。有多个PNI的患者的临床预后比单发PNI的患者差(MCF12.4vs.18.0-Mo，p=0.040；MOS：39.7Movs.NR，p=0.018)或无PNI的患者(MCF12.4vs.18.5Mo，p=0.002；MOS：39.7vs.71.4Mo，p=0.002)。总体而言，在多因素分析中，单PNI和多PNI都不是影响生存结果的独立危险因素。然而，值得注意的是，对于有利/中等风险的MPCa患者，多PNI是CFS和OS的独立不良预测因素(CFS：HR：1.705，95%CI：1.029-2.825，p=0.038；OS：HR：3.294，95%CI：1.464-7.413，p=0.004)。讨论与结论本研究填补了PNI在MPCa中临床意义的空白。我们发现，多项PNI可以区分预后相对较差的患者和其他预后指标最初认为预后良好的患者，从而避免在这类患者中低估疾病。我们的发现将有助于医生更深入地了解MPCA的异质性，并制定更好的个体化治疗策略。
Background The clinical value of perineural invasion (PNI) in patients with localized prostate cancer (PCa) is widely explored. However, its role in metastatic PCa (mPCa) remains unknown. Objectives We aim to investigate the clinical significance of PNI in patients with mPCa. Materials and methods Data of 515 mPCa patients between 2012 and 2018 were retrospectively studied. PNI and its intensity were identified by prostate biopsy. The prognostic value of PNI was evaluated by Kaplan-Meier curves and Cox proportional-hazards model. Results Perineural invasion was detected in 170/515 (33.0%) cases. Among them 73/170 (42.9%) and 97/170 (57.1%) harbored unifocal PNI (uni-PNI) and multifocal PNI (multi-PNI), respectively. Compared to patients without PNI, those with PNI had statistically shorter castration-resistant PCa-free survival (CFS) and numerically shorter overall survival (OS) (mCFS: 15.4- vs. 18.5-Mo, p = 0.015; mOS: 63.8- vs. 71.4-Mo, p = 0.108). Patients harboring multi-PNI were associated with poorer clinical outcomes than those with uni-PNI (mCFS: 12.4- vs. 18.0-Mo, p = 0.040; mOS: 39.7-Mo vs. NR, p = 0.018) or those without PNI (mCFS: 12.4- vs. 18.5-Mo, p = 0.002; mOS: 39.7- vs. 71.4-Mo, p = 0.002). Totally, neither uni-PNI nor multi-PNI was an independent risk factor impacting survival outcomes in multivariate analyses. While remarkably, for patients with favorable/intermediate-risk mPCa, multi-PNI was an independent adverse prognosticator for both CFS and OS (CFS: HR: 1.705, 95% CI: 1.029-2.825, p = 0.038; OS: HR: 3.294, 95% CI: 1.464-7.413, p = 0.004). Discussion and Conclusion This study filled the blank of the clinical significance of PNI in mPCa. We found that multi-PNI could distinguish men with relatively poor prognosis from patients initially regarded as with favorable survival outcomes by other prognosticators, and thus, avoid disease underestimation in this group of patients. Our finding would help physicians have a deeper understanding of the heterogeneity of mPCa and make better individualized therapeutic strategy.