前列腺导管腺癌临床特征及腺外侵犯的影响因素

doi:10.19723/j.issn.1671-167X.2025.05.021

Abstract

Abstract: Objective: To explore the differences in perioperative clinical and pathological characteristics of patients with different pathological types of prostate cancer undergoing radical prostatectomy, and to analyze the influencing factors that may affect the extraglandular invasion of ductal adenocarcinoma of the prostate. Methods: Retrospective collection was made of the radical prostatectomy patients who were admitted to Peking University Third Hospital from December 2011 to April 2021. The patients were screened based on inclusion criteria to obtain basic clinical features and postoperative pathological results. According to the pathological results, the patients were divided into ductal adenocarcinoma group (mixed with ductal adenocarcinoma) and acinar adenocarcinoma group, and a 1 ∶1 propensity score matching was performed to compare the differences in clinical characteristics between the two groups. Univariate and multivariate analyses of the factors related to extraglandular invasion were performed in the matched ductal adenocarcinoma groups. Results: A total of 764 patients with prostate cancer were enrolled in this study, of which 62 patients were confirmed to have ductal adenocarcinoma components by postoperative pathology. There was a statistically significant difference in the proportion of the patients with a history of diabetes in baseline characteristics between the two groups before propensity score matching (29.5% vs. 17.7%, P=0.027). A total of 61 patients with simple acinar adenocarcinoma were successfully matched with the patients with ductal adenocarcinoma, and there was no statistically significant difference in baseline characteristics between the two groups after matching (P>0.05). The comparison of perioperative clinical and pathological features showed that International Society of Urology Pathology (ISUP) grade (P=0.003), pT stage (P=0.004), extraglandular invasion rate (P=0.018) and vascular thrombus rate (P=0.019) in ductal adenocarcinoma group were significantly higher than those in simple acinous adenocarcinoma group. Univariate analysis of the influence factors of extraglandular invasion showed that prostate-specific antigen (PSA) level, prostate volume, ISUP grade, seminal vesicle invasion and perineural invasion might be the influencing factors of extraglandular invasion (P < 0.10). Binary Logistic regression analysis showed that perineural invasion was an independent factor of extraglandular invasion (OR=11.78, 95%CI: 1.97-70.56, P=0.007). Conclusion: Prostatic ductal adenocarcinoma has a worse prognosis than simple acinar adenocarcinoma. Perineural invasion is the influencing factor of extraglandular invasion of ductal adenocarcinoma.

Key words: Prostatic neoplasms, Ductal adenocarcinoma, Neoplasm invasiveness, Prostatectomy, Risk factors

CLC Number:

R737.25

Xiaoyong YANG, Fan ZHANG, Lulin MA, Cheng LIU. Clinical characteristics and influencing factors of extraglandular invasion of prostatic ductal adenocarcinoma[J].Journal of Peking University (Health Sciences), 2025, 57(5): 956-960.

Figures/Tables 2

Table 1

Table 2

References 14

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Items	DAP (n=61)	PAA (n=61)	P value
Age/years, ${\bar x}$±s	69.39±6.66	68.85±7.54	0.675
BMI/(kg/m²), ${\bar x}$±s	25.13±2.94	24.98±3.17	0.783
Hypertension, n(%)	33 (54.1)	34 (55.7)	0.856
Diabetes, n(%)	18 (29.5)	17 (27.9)	0.841
History of malignancy, n(%)	2 (3.3)	1 (1.6)	0.641
History of prostatic operation, n(%)	3 (4.9)	2 (3.3)	0.641
PSA/(μg/L), M(Q₁, Q₃)	11.80 (6.18, 26.89)	10.22 (5.83, 19.51)	0.408
Prostate volume/mL, M(Q₁, Q₃)	40.00 (30.15, 52.65)	39.51 (26.36, 52.18)	0.519
ISUP grade, n(%)			0.003
1	1 (1.6)	8 (13.1)
2	7 (11.5)	18 (29.5)
3	7 (11.5)	7 (11.5)
4	16 (26.2)	13 (21.3)
5	30 (49.2)	15 (24.6)
Positive margin, n(%)	26 (42.6)	24 (39.3)	0.713
Extraglandular invasion, n(%)	40 (65.6)	27 (44.3)	0.018
Seminal vesicle invasion, n(%)	13 (21.3)	8 (13.1)	0.230
Perineural invasion, n(%)	51 (83.6)	43 (70.5)	0.085
Vascular cancer thrombus, n(%)	16 (26.2)	6 (9.8)	0.019
pT, n(%)			0.004
2	19 (31.1)	33 (54.1)
3	37 (60.7)	28 (45.9)
4	5 (8.2)	0
Surgical duration/min, M(Q₁, Q₃)	218 (185, 256)	221 (187, 251)	0.828
Blood loss/mL, M(Q₁, Q₃)	50 (50, 150)	50 (50, 175)	0.647

Items	Extraglandular invasion		P value
Items	Positive (n=40)	Negative (n=21)	P value
Age/years, ${\bar x}$±s	69.10±6.64	69.95±6.82	0.639
BMI/(kg/m²)，${\bar x}$±s	25.33±2.78	24.74±3.24	0.454
PSA/(μg/L), M (Q₁, Q₃)	15.08 (7.22, 36.64)	9.83 (4.77, 13.32)	0.054
Volume/mL, M (Q₁, Q₃)	36.95 (28.58, 47.15)	44.80 (34.10, 55.10)	0.074
ISUP, n(%)			0.017
1	1 (2.5)	0
2	2 (5.0)	5 (23.8)
3	2 (5.0)	5 (23.8)
4	12 (30.0)	4 (19.0)
5	23 (57.5)	7 (33.3)
Positive margin, n(%)	16 (40.0)	10 (47.6)	0.568
Seminal vesicle invasion, n(%)	12 (30.0)	1 (4.8)	0.024
Perineural invasion, n(%)	38 (95.0)	13 (61.9)	0.002
Vascular cancer thrombus, n(%)	13 (32.5)	3 (14.3)	0.124

Clinical characteristics and influencing factors of extraglandular invasion of prostatic ductal adenocarcinoma

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