Metastatic patterns of prostate cancer:: An autopsy study of 1,589 patients
Metastatic patterns of prostate cancer:: An autopsy study of 1,589 patients
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DOI：
10.1053/hp.2000.6698
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发表时间：
2000-05-01
期刊：
影响因子：
3.3
通讯作者：
Mihatsch, MJ
中科院分区：
文献类型：
--
作者：
Bubendorf, L;Schöpfer, A;Mihatsch, MJ
前列腺癌的预后主要取决于是否存在转移。然而，前列腺癌的转移途径还不完全清楚。在1967年至1995年对40岁以上男性进行的19，316例常规尸检中，分析了1，589例（8.2%）前列腺癌的报告。在1,589例前列腺癌患者中，35%存在血源性转移，最常见的累及部位为骨（90%）、肺（46%）、肝（25%）、胸膜（21%）和肾上腺（13%）。一些证据表明，除了经典的血源性肿瘤通过腔静脉扩散外，还存在通过前列腺静脉到脊柱的向后转移途径。首先，脊柱和肺转移之间呈负相关，表明脊柱转移与肺转移无关。其次，与最大扩散至肺（6 - 8 cm）和肝（>8 cm）相比，脊柱受累的最大频率发生在较小肿瘤（4 - 6 cm）中，这表明在许多前列腺癌中脊柱转移先于肺和肝转移。第三，从腰椎到颈椎的脊柱受累逐渐减少（97%对38%），这与初始腰椎转移后随后沿沿着脊柱静脉向上转移一致。本研究的结果显示，骨、肺和肝是前列腺癌远处转移的最常见部位，除了通过肺通道的腔型转移外，有强有力的论据支持向后静脉扩散到脊柱的存在和临床意义，这可能发生在转移过程的早期。Copyright（C）2000 by W.B.桑德斯公司
The prognosis of prostate cancer is mainly determined by the presence or absence of metastases. Nevertheless, the metastatic pathways in prostate cancer are not entirely understood. Among 19,316 routine autopsies performed from 1967 to 1995 on men older than 40 years of age, the reports from those 1,589 (8.2%) with prostate cancer were analyzed. Hematogeneous metastases were present in 35% of 1,589 patients with prostate cancer, with most frequent involvement being bone (90%), lung (46%), liver (25%), pleura (21%), and adrenals (13%). Several lines of evidence suggested the existence of a backward metastatic pathway through veins from the prostate to the spine in addition to classical hematogeneous tumor spread via the vena cava. First, there was an inverse relationship between spine and lung metastases, suggesting that metastasis to the spine is independent of lung metastasis. Second, the maximum frequency of spine involvement occurred in smaller tumors (4 to 6 cm) as compared with the maximum spread to lung (6 to 8 cm) and liver (>8 cm), suggesting that spine metastases precede lung and liver metastases in many prostate cancers. Third, there was a gradual decrease in spine involvement from the lumbar to the cervical level (97% v 38%), which is consistent with a subsequent upward metastatic spread along spinal veins after initial lumbar metastasis. The results of this study show that bone, lung, and liver are the most frequent sites of distant prostate cancer metastases, Besides the cava-type of metastasis through lung passage, there are strong arguments for the existence and clinical significance of a backward venous spread to the spine, which is likely to occur early in the metastatic process. Copyright (C) 2000 by W.B. Saunders Company.