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合并神经内分泌分化前列腺腺癌23例病例报告及文献复习
引用本文:邓梁,龙智,何乐业,汤进,刘建业,刘斌,姚鲲,张一川. 合并神经内分泌分化前列腺腺癌23例病例报告及文献复习[J]. 中华男科学杂志, 2020, 0(1): 42-47
作者姓名:邓梁  龙智  何乐业  汤进  刘建业  刘斌  姚鲲  张一川
作者单位:;1.中南大学湘雅三医院泌尿外科;2.中南大学前列腺疾病研究所
基金项目:湖南省自然科学基金(2017JJ2370)。
摘    要:目的:探讨合并神经内分泌分化(NED)前列腺腺癌的临床特征及预后,提高对神经内分泌癌的认识。方法:回顾性分析2005年至2018年收治的23例确诊前列腺腺癌伴NED患者的临床资料。结果:23例病例中,18例以下尿路症状(LUTS)来就诊。所有患者病理诊断为腺癌并局灶NED,其中2例第1次病理诊断为腺癌,内分泌治疗出现去势抵抗后,再次病理检查发现部分NED。所有患者均接受了内分泌治疗,3例患者接受了根治性手术治疗,并行辅助化疗、放疗或内分泌治疗;13例患者接受了姑息性经尿道前列腺等离子电切术(pTUPKRP)和辅助内分泌治疗,其中2例出现去势抵抗,再次接受pTU-PKRP,并给予化疗;2例患者因盆腔广泛转移,导致梗阻性肾病(尿毒症期),接受了经皮肾穿刺造瘘引流术和内分泌治疗;余5例患者仅行单纯内分泌治疗或联合放疗。随访7~60个月后,2例因肿瘤进展死亡,1例死于肺部感染,其余患者均存活。结论:长期的内分泌治疗可能导致前列腺腺癌发生NED改变,根治性手术结合辅助治疗是治疗早期患者的主要方式;内分泌治疗联合经尿道手术可以改善中晚期患者的LUTS,提高生活质量。

关 键 词:前列腺腺癌  神经内分泌分化  治疗  生活质量

Neuroendocrine differentiated prostate adenocarcinoma: Report of 23 cases and review of the literature
DENG Liang,LONG Zhi,HE Le-ye,TANG Jin,LIU Jian-ye,LIU Bin,YAO Kun,ZHANG Yi-chuan. Neuroendocrine differentiated prostate adenocarcinoma: Report of 23 cases and review of the literature[J]. National journal of andrology, 2020, 0(1): 42-47
Authors:DENG Liang  LONG Zhi  HE Le-ye  TANG Jin  LIU Jian-ye  LIU Bin  YAO Kun  ZHANG Yi-chuan
Affiliation:(Department of Urology,The Third Xiangya Hospital,Central South University,Changsha,Hunan 410013,China;Research Institute of Prostatic Diseases,Central South University,Changsha,Hunan 410013,China)
Abstract:Objective:To study the clinical features and prognosis of neuroendocrine differentiated prostate adenocarcinoma(NED/AdPC).Methods:We retrospectively analyzed the clinical data on 23 cases of NED/AdPC treated between 2005 and 2018,among which,18 had lower urinary tract symptoms(LUTS).Results:All the 23 patients were diagnosed with NED/AdPC,including 2 cases of AdPC initially diagnosed and confirmed with neuroendocrine differentiation in a second pathological diagnosis after androgen deprivation therapy(ADT).In addition to hormonal therapy for all the cases,3 of the patients were treated by radical prostatectomy combined with adjuvant chemo-and radiotherapy,13 by palliative transurethral bipolar plasmakinetic resection of the prostate(pTU-PKRP),of whom 2 underwent a second pTU-PKRP and chemotherapy for castration resistance,2 with chronic renal insufficiency by percutaneous nephrostomy because of extensive pelvic metastasis,and the other 5 by ADT alone or in combination with radiother apy.During the follow-up of 7 to 60 months,2 of the patients died of cancer progression and 1 of pulmonary infection,while the others survived with effective control of the tumor.Conclusion:Long-term ADT may induce neuroendocrine differentiation in AdPC patients.For early-stage NED/AdPC,radical prostatectomy combined with adjuvant therapy is a main therapeutic option,while for advanced NED/AdPC,pTU-PKRP in combination with ADT may relieve LUTS and improve the patients'quality of life.
Keywords:prostate adenocarcinoma  neuroendocrine differentiation  therapy  quality of life
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