Metastatic prostate carcinoma to bone - Clinical and pathologic features associated with cancer-specific survival
Metastatic prostate carcinoma to bone - Clinical and pathologic features associated with cancer-specific survival
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DOI：
10.1002/cncr.10788
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发表时间：
2002-09-01
期刊：
影响因子：
6.2
通讯作者：
Blute, ML
中科院分区：
文献类型：
--
作者：
Cheville, JC;Tindall, D;Blute, ML
背景本研究的目的是在一个大的男性队列中检查前列腺癌骨转移的临床和病理特征，以及这些特征与预后的关系。68例因前列腺癌转移到骨而接受手术以稳定病理性骨折或即将发生的骨折的男性进行了研究。临床特征包括原发性和转移性前列腺癌的治疗类型、诊断转移性前列腺癌时的年龄和血清前列腺特异性抗原（PSA）、转移的放射学结果（成骨细胞、溶骨性或混合性）以及转移手术时的转移部位数量。检查的病理特征包括转移性前列腺癌的Gleason评分。所有病例均行DAM-1、细胞角蛋白、PSA、突触素、嗜铬粒蛋白A、5-羟色胺、雌激素受体、孕激素受体和雄激素受体的免疫组化染色。Kaplan-Meier方法用于估计癌症特异性生存期。随访持续时间定义为从转移瘤手术日期至死亡或末次随访日期的时间间隔。单变量和多变量考克斯比例风险模型被用来评估与前列腺癌死亡相关的特征。从前列腺癌转移手术到死亡的平均（标准差）时间为1.5（1.9）年，范围从0天到10年，中位数为1年。1年、2年和3年的估计癌症特异性生存率分别为54.3%、28.8%和22.9%。中位癌症特异性生存期为1.1年。经过4年的随访，只有7名患者有死于前列腺癌的风险。发现与前列腺癌死亡显著相关的特征单变量包括转移诊断和转移手术之间的时间间隔（P < 0.001），术前雄激素阻断治疗对转移瘤的影响（P = 0.002），伴有转移（P = 0.003），转移部位数Gleason评分（P = 0.002）和嗜铬粒蛋白A阳性（P = 0.041）。多因素分析显示，从确诊转移到手术治疗转移的时间间隔（P < 0.001）、转移灶Gleason评分（P < 0.001）和嗜铬粒蛋白A阳性（P = 0.009）与前列腺癌死亡显著相关。尽管前列腺癌骨转移患者手术后的癌症特异性生存率很差，但转移瘤的肿瘤分化和嗜铬粒蛋白A阳性的评估提供了预后信息。
BACKGROUND. The objective of this study was to examine the clinical and pathologic features of metastatic prostate carcinoma to bone in a large cohort of men, and the associations of these features with outcome.METHODS. Sixty-eight men who underwent surgery for metastatic prostate carcinoma to bone for stabilization of a pathologic fracture or impending fracture were studied. Clinical characteristics included the type of treatment for the primary and metastatic prostate carcinoma, age and serum prostate specific antigen (PSA) at the diagnosis of the metastatic prostate carcinoma, radiographic findings of the metastasis (osteoblastic, osteolytic, or mixed), and the number of metastatic sites at the time of the surgery for the metastasis. Pathologic features examined included Gleason score of the metastatic prostate carcinoma. Immunohistochemical stains for DAM-1, cytokeratin, PSA, synaptophysin, chromogranin A, serotonin, estrogen receptor, progesterone receptor, and androgen receptor were performed for all cases. The Kaplan-Meier method was used to estimate cancer-specific survival. The duration of follow-up was defined as the interval from the date of surgery for the metastasis to the date of death or last follow-up. Univariate and multivariate Cox proportional hazards models were fit to assess the features that were associated with death from prostate carcinoma.RESULTS. The average (standard deviation) time from the surgery for the metastasis to death from prostate carcinoma was 1.5 (1.9) years, ranging from 0 days to 10 years, with a median of I year. The estimated cancer-specific survival rates at I year, 2 years, and 3 years were 54.3%, 28.8%, and 22.9%, respectively. Median cancer-specific survival occurred at 1.1 years. After 4 years of follow-up, there were only seven patients left at risk for death from prostate carcinoma. Features that were found to be significantly associated with death from prostate carcinoma univariately included the interval between the diagnosis of metastasis and the surgery for metastasis (P < 0.001), androgen deprivation therapy before surgery for the metastasis (P = 0.002), presentation with metastasis (P = 0.003), the number of metastatic sites (P = 0.034), Gleason score of the metastasis (P = 0.002), and tumor positivity for chromogranin A (P = 0.041). On multivariate analysis, the interval between the diagnosis of metastasis and the surgery for metastasis (P < 0.001), Gleason score of the metastasis (P < 0.001), and tumor positivity for chromogranin A (P = 0.009) were associated significantly with death from prostate carcinoma.CONCLUSIONS. Although cancer-specific survival for patients after surgery for prostate carcinoma metastatic to bone is poor, assessments of tumor differentiation of the metastasis and chromogranin A positivity provide prognostic information.