Clinicopathologic characteristics and prognosis of early onset prostate cancer

目的 探讨年轻(≤55岁)前列腺癌患者的临床病理特征及预后.方法 收集2000年1月1日至2016年8月31日在北京大学第三医院和北京大学首钢医院就诊并获得明确病理诊断的原发性年轻(≤55岁)前列腺癌患者28例,其中根治标本18例,穿刺标本10例;并收集同期老年(>55岁)前列腺癌根治术患者445例,将具有详细病理信息的385例作为对照.年轻患者平均年龄51岁(29~55岁),中位年龄53岁,获得完善随访资料22例,随访时间1~110个月.回顾性分析年轻前列腺癌患者的临床病理特点,对影响根治标本病理分期的相关因素进行统计,并分析其预后与临床病理特征之间的相关性.结果 年轻前列腺癌患者术前18例(64.3%)游离前列腺特异性抗原(PSA)升高,26例(92.9%)总PSA升高,26例(92.9%)游离PSA/总PSA降低.Gleason评分:5例(17.8%)6分,8例(28.6%)7分,3例(10.7%)8分,12例(42.9%)9分.根治标本中,10例(55.6%)患者T分期为pT2c期,7例(38.9%)患者pT3期,术前游离PSA水平(P=0.006)和Gleason评分(P=0.001)与T分期显著正相关.2例(9.1%)患者有前列腺癌家族病史,均为一级亲属患病;2例(9.1%)因前列腺癌死亡,7例(31.8%)术后24个月以内出现疾病进展.年轻患者与老年患者在术前PSA水平及Gleason评分等方面差异无统计学意义,但前者更容易出现尿失禁手术并发症(P=0.023)及术后PSA水平异常(P=0.001).生存分析结果显示,年轻组的总生存期显著低于老年组(P=0.049),术后PSA水平与年轻患者的总生存期(P=0.030)及无病生存期(P=0.021)显著负相关.结论 年轻患者的前列腺癌进展迅速,术前游离PSA水平和Gleason评分与前列腺癌进展关系密切.与老年患者相比,年轻患者的总生存期显著降低,且更容易出现尿失禁手术并发症及术后PSA水平异常.其中,术后PSA水平异常是影响年轻前列腺癌患者预后的不良因素.年轻前列腺癌患者,尤其是有家族史的人群,可能从易感基因位点及分子分型的研究中获益.Objective To observe the clinicopathologic features and prognosis of prostate cancer (PCa) in young men.Methods Twenty-eight early onset (≤55 years) patients with PCa pathologically confirmed in the Peking University Third Hospital and Peking University Shougang Hospital from January 1st 2000 to August 31st 2016 were collected.There were 18 radical prostatectomy (RP) cases and 10 transrectal prostatic biopsy cases.Contemporaneously, 445 elderly (>55 years) patients were collected, of which 385 had detailed pathological information, were chosen as control group.The mean age of young group was 51 years (29-55 years).Follow-up data for 22 cases were available (1-110 months).The correlation of the clinicopathological features and prognosis were analyzed retrospectively.Results Presurgical prostatic specific antigen (PSA) level was abnormal in young patients, with 18 cases (64.3%) had elevated fPSA level, 26 (92.9%) had increased tPSA level, and 26 (92.9%) had decreased fPSA/tPSA ratio.Gleason score (GS) was 8 in 10.7% (3/28) of cases, and 9 in 42.9% (12/28) of cases.Of the 18 patients with RP, 17 (94.4%) had pT stage ≥pT2c.PSA level (P=0.006) and GS (P=0.001) were positively correlated with pT stage.Family history of PCa in 1st degree relatives was found in 9.1% of the cases.During follow-up, 2 patients died of PCa, 7 patients showed progression within 24 months.There were no significant differences in PSA level and GS between young patients and elderly patients, while the former group was more likely to have incontinence (P=0.023), higher PSA levels (P=0.001), and lower overall survival (P=0.049).Only postsurgical PSA level was found to be negatively associated with overall survival (P=0.030) and cancer specific survival (P=0.021) in young patients.Conclusions Presurgical PSA level and GS are positively correlated with pT stage of early onset PCa.Compared with elderly patients, young patients are more likely to have incontinence, higher postsurgical PSA level, and lower overall survival.Among all the parameters, only postsurgical PSA level shows an adverse impact on prognosis of early onset PCa.Young patients, especially those with family history, may benefit from studies on the susceptibility loci and phenotype of PCa.中国科学引文数据库(CSCD)6373-3774