摘要
目的:探讨前列腺黏液腺癌的临床特点及治疗策略。方法:回顾性分析2014年1月至2018年6月南京医科大学第一附属医院泌尿外科10例前列腺黏液腺癌患者的临床资料,患者年龄(65±14)岁(51~79岁),术前中位PSA 89μg/L(14.63~128.05μg/L)。前列腺穿刺确诊前列腺黏液腺癌,Gleason评分3+3分1例,3+4分2例,4+3分1例,8分6例。1例行机器人辅助下根治性前列腺切除术,9例行腹腔镜下根治性前列腺切除术,均行标准盆腔淋巴结清扫术,分析其预后生存情况。结果:10例手术均顺利完成。病理提示前列腺黏液腺癌共10例,其中黏液腺癌合并印戒细胞癌2例。10例患者中,术后病理分期≤T2b 2例(20%),≥T2c 5例(50%),盆腔淋巴结清扫阳性患者3例(30%),切缘阳性患者5例(50%)。中位随访时间26个月(6~48月),术后2年4例患者出现了生化复发,经全雄阻断治疗及放化疗等辅助治疗后,末次随访PSA均<1.0μg/L。结论:前列腺黏液腺癌的预后良好,中低危黏液腺癌建议根治手术治疗;而黏液腺癌术后生化复发通过辅助全雄阻断综合治疗,患者也可受益。
Objective:To investigate the clinical characteristics and treatment strategies of prostatic mucinous adenocarcinoma(PMAC).Methods:We retrospectively analyzed the clinical data on 10 cases of PMAC treated in the First Affiliated Hospital of Nanjing Medical University from January 2014 to June 2018.The patients were aged 51-79(65±14)years,with a medium PSA level of 89(14.63-128.05)μg/L and Gleason scores of 3+3 in 1 case,3+4 in 2,4+3 in 1 and 8 in 6 cases preoperatively,1 treated by robot-assisted radical prostatectomy and the other 9 by laparoscopic radical prostatectomy.We conducted pelvic cavity lymph node dissection for all the patients and analyzed their prognosis and survival.Results:Operations were successfully completed in all the cases.Pathological examination revealed 2 cases of mucinous adenocarcinoma with signet ring cell carcinoma in the 10 PMAC patients,2 at stage≤T2 b,5 at stage≥T2 c,3 positive at pelvic lymph node dissection and 5 positive at the incision margin.The patients were followed up for 6-48(median 26)months.Four of the patients were found with biochemical recurrence within 2 years after operation and treated by androgen-deprivation therapy,radiotherapy and chemotherapy,which reduced the PSA level to<1.0μg/ml in all the 4 cases.Conclusion:PMAC has a good prognosis.Radical surgery is recommended for moderate and low-risk PMAC and the patients with postoperative biochemical recurrence can benefit from comprehensive treatment of total androgen blockade.
作者
袁海建
游泽斌
李光耀
陈杏林
王仪春
鲍美玲
王尚乾
苏仕峰
秦超
王巍
YUAN Hai-jian;YOU Ze-bin;LI Guang-yao;CHEN Xing-lin;WANG Yi-chun;BAO Mei-ling;WANG Shang-qian;SU Shi-feng;QIN Chao;WANG Wei(Department of Urology,The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China;Department of Urology,Hai'an People's Hospital Affiliated to Nantong University,Nantong,Jiangsu 226000,China;Department of Pathology,The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China)
出处
《中华男科学杂志》
CAS
CSCD
北大核心
2020年第12期1087-1091,共5页
National Journal of Andrology
关键词
前列腺黏液腺癌
生化复发
内分泌治疗
prostatic mucinous adenocarcinoma
biochemical recurrence
endocrine therapy
