- 作者：Daniel J. Krauss M.D.&lowast ; ; ; dkrauss@beaumont.edu ; Sylvia Hayek M.D.&dagger ; ; Mitual Amin M.D.&dagger ; ; Hong Ye M.S.&lowast ; ; Larry L. Kestin M.D.&lowast ; ; Steven Zadora&dagger ; ; Frank A. Vicini M.D.&lowast ; ; Matthew Cotant M.D.&Dagger ; ; Donald S. Brabbins M.D.&lowast ; ; Michel I. Ghilezan M.D.&lowast ; ; Gary S. Gustafson M.D.&lowast ; ; Alvaro A. Martinez M.D. ; F.A.C.R.&lowast ;
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2011
- 出版时间：1 November 2011
- 年：2011
- 卷：81
- 期：3
- 页码：e119-e125
- 全文大小：421 K
Purpose
To determine the prognostic significance of neuroendocrine differentiation (NED) in Gleason score 8?0 prostate cancer treated with primary radiotherapy (RT).Methods and Materials
Chromogranin A (CgA) staining was performed and overseen by a single pathologist on core biopsies from 176 patients from the William Beaumont prostate cancer database. A total of 143 had evaluable biopsy material. Staining was quantified as 0 % , <1 % , 1?0 % , or >10 % of tumor cells. Patients received external beam RT alone or together with high-dose-rate brachytherapy. Cox regression and Kaplan-Meier estimates determined if the presence/frequency of neuroendocrine cells correlated with clinical endpoints.
Results
Median follow-up was 5.5 years. Forty patients (28 % ) had at least focal positive CgA staining (<1 % n?= 21, 1?0 % n?= 11, >10 % n?= 8). No significant differences existed between patients with or without staining in terms of age, pretreatment prostate-specific antigen, tumor stage, hormone therapy administration, % biopsy core involvement, mean Gleason score, or RT dose/modality. CgA staining concentration independently predicted for biochemical and clinical failure, distant metastases (DM), and cause-specific survival (CSS). For patients with <1 % vs. >1 % staining, 10-year DM rates were 13.4 % vs. 55.3 % , respectively (p?= 0.001), and CSS was 91.7 % vs. 58.9 % (p?<?0.001). As a continuous variable, increasing CgA staining concentration predicted for inferior rates of DM, CSS, biochemical control, and any clinical failure. No differences in outcomes were appreciated for patients with 0 % vs. <1 % NED.
Conclusions
For Gleason score 8?0 prostate cancer, >1 % NED is associated with inferior clinical outcomes for patients treated with radiotherapy. This relates most directly to an increase in distant disease failure.