Abstract：
BACKGROUND: Prostate cancer presents with soft tissue progression (STP) is highly aggressive. We analyzed the risk factor for STP in patients with metastatic castration-resistant prostate cancer (mCRPC) who developed abiraterone acetate (AA) resistance.
METHODS: This retrospective study included patients with mCRPC who received AA between February 2018 and July 2022. STP was defined as recurrent lesions in situ, multiple regional lymph node metastases (mLNM), or visceral metastases. Clinical features of patients with STP were analyzed, and risk factors for STP were further investigated.
RESULTS: Sixty-three patients (mean age, 75.0 years; median follow-up time, 22.3 months) were included in this study. Twenty-three patients (36.5%) presented STP during follow up, the overall survival (OS) after STP was 4.6 months. The serum neuron-specific enolase (NSE) were significantly elevated in patients with STP. Biopsies for 8 patients with STP showed neuroendocrine prostate cancer (NEPC, n = 5) was the major pathological types. Further analysis showed that perineural invasion (PNI) in primary tumor were the independent risk factors (HR = 3.145, P = 0.020) for STP, and PNI was related to the aggressiveness of tumor. Patients with PNI showed shorter castration-resistant progression free survival (median, 23.73 months vs. 25.59 months) and STP progression free survival (median, 19.7 months vs. not reached) compared with patients without PNI.
CONCLUSIONS: STP showed extremely poor prognoses in patients with mCRPC after AA resistance, NEPC is the main pathological type of STP, and PNI in primary tumor was an independent risk factor for STP and indicated poor prognosis of prostate cancer.
METHODS: This retrospective study included patients with mCRPC who received AA between February 2018 and July 2022. STP was defined as recurrent lesions in situ, multiple regional lymph node metastases (mLNM), or visceral metastases. Clinical features of patients with STP were analyzed, and risk factors for STP were further investigated.
RESULTS: Sixty-three patients (mean age, 75.0 years; median follow-up time, 22.3 months) were included in this study. Twenty-three patients (36.5%) presented STP during follow up, the overall survival (OS) after STP was 4.6 months. The serum neuron-specific enolase (NSE) were significantly elevated in patients with STP. Biopsies for 8 patients with STP showed neuroendocrine prostate cancer (NEPC, n = 5) was the major pathological types. Further analysis showed that perineural invasion (PNI) in primary tumor were the independent risk factors (HR = 3.145, P = 0.020) for STP, and PNI was related to the aggressiveness of tumor. Patients with PNI showed shorter castration-resistant progression free survival (median, 23.73 months vs. 25.59 months) and STP progression free survival (median, 19.7 months vs. not reached) compared with patients without PNI.
CONCLUSIONS: STP showed extremely poor prognoses in patients with mCRPC after AA resistance, NEPC is the main pathological type of STP, and PNI in primary tumor was an independent risk factor for STP and indicated poor prognosis of prostate cancer.
摘要：
背景：伴有软组织进展（STP）的前列腺癌具有高度侵袭性。我们分析了发生醋酸阿比特龙（AA）耐药的转移性去势耐药前列腺癌（mCRPC）患者STP的危险因素。
方法：这项回顾性研究包括2018年2月至2022年7月接受AA的mCRPC患者。STP定义为原位复发病变，多区域淋巴结转移（mLNM），或内脏转移。分析STP患者的临床特点,并进一步调查了STP的危险因素。
结果：63例患者（平均年龄，75.0年；中位随访时间，22.3个月)纳入本研究。23例(36.5%)患者在随访期间出现STP,STP后的总生存期(OS)为4.6个月.STP患者血清神经元特异性烯醇化酶（NSE）明显升高。8例STP患者的活检显示神经内分泌前列腺癌（NEPC，n=5）是主要的病理类型。进一步分析显示原发肿瘤神经周浸润(PNI)是STP的独立危险因素(HR=3.145,P=0.020),PNI与肿瘤的侵袭性有关。PNI患者的去势抵抗无进展生存期较短(中位数，23.73个月vs.25.59个月）和STP无进展生存期（中位数，19.7个月vs.未达到）与没有PNI的患者相比。
结论：在AA抵抗后的mCRPC患者中，STP显示出极差的预后，NEPC是STP的主要病理类型,原发灶中的PNI是STP的独立危险因素，提示前列腺癌预后不良。
方法：这项回顾性研究包括2018年2月至2022年7月接受AA的mCRPC患者。STP定义为原位复发病变，多区域淋巴结转移（mLNM），或内脏转移。分析STP患者的临床特点,并进一步调查了STP的危险因素。
结果：63例患者（平均年龄，75.0年；中位随访时间，22.3个月)纳入本研究。23例(36.5%)患者在随访期间出现STP,STP后的总生存期(OS)为4.6个月.STP患者血清神经元特异性烯醇化酶（NSE）明显升高。8例STP患者的活检显示神经内分泌前列腺癌（NEPC，n=5）是主要的病理类型。进一步分析显示原发肿瘤神经周浸润(PNI)是STP的独立危险因素(HR=3.145,P=0.020),PNI与肿瘤的侵袭性有关。PNI患者的去势抵抗无进展生存期较短(中位数，23.73个月vs.25.59个月）和STP无进展生存期（中位数，19.7个月vs.未达到）与没有PNI的患者相比。
结论：在AA抵抗后的mCRPC患者中，STP显示出极差的预后，NEPC是STP的主要病理类型,原发灶中的PNI是STP的独立危险因素，提示前列腺癌预后不良。
